Kidney Week

Abstract: SA-PO740

Avacopan for Granulomatosis with Polyangiitis (GPA) and Microscopic Polyangiitis (MPA) in a Real-World Setting

Session Information

• ANCA-Associated Vasculitis, Anti-GBM Disease, and Other RPGN
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Wallace, Zachary S., Massachusetts General Hospital Department of Medicine, Boston, Massachusetts, United States

Zachary S. Wallace, MD, MSc

• Oh, Sam S., , Thousand Oaks, California, United States

Sam S. Oh, PhD, MPH

• Trimpe, Darcy, , Thousand Oaks, California, United States

Darcy Trimpe, PhD

• Inguva, Sushmitha, , Thousand Oaks, California, United States

Sushmitha Inguva, MS, PhD

• Patel, Naomi J., Massachusetts General Hospital Department of Medicine, Boston, Massachusetts, United States

Naomi J. Patel, MD, MPH

Background

Avacopan is approved for use in adults with severe active GPA/MPA in the US. Data on avacopan in the real-world setting are limited.

Methods

This is an ongoing retrospective cohort study including patients from 12/1/21 to 4/1/24 prescribed avacopan for GPA/MPA at Mass General Brigham. Data are extracted by manual review and as structured data. Data from -12 to +6 months are reported. Complete remission (CR) is defined as Birmingham Vasculitis Activity Score (BVAS v3)=0 at month 6 and no glucocorticoids (GC) after month 5.

Results

At the prescription date in the first 80 patients (Fig. 1), mean age was 59 years, and most were female (70%), newly diagnosed (65%), MPO-ANCA+ (60%), and had MPA (53%). Nephrologists were the most frequent prescribers (56%). Of these 80 patients, 67 initiated avacopan. At initiation, 46% had renal involvement by BVAS (median eGFR 24 ml/min/1.73m²; urine protein-to-creatinine ratio (UPCR) 1.9g/g). Among the 67 initiators at month 6, median cumulative GC dose was 1,011mg, 82% had BVAS=0, and 66% achieved CR. All 5 patients with ≥1 dialysis session ±30 days of initiation stopped dialysis by month 6; 4 newly initiated dialysis ≥30 days post-avacopan start. Of the 11 with eGFR <20 ml/min/1.73m² at initiation, 5 had eGFR ≥ 30 ml/min/1.73m² by month 6. By month 6, UPCR was 0.5g/g. Of the 35 GC users who discontinued GC by month 6, the median time from avacopan initiation to GC discontinuation was 50 days. At month 6, 43 remained on avacopan; 8 completed a planned 6-month course and 9 discontinued for AEs.

Conclusion

In this real-world GPA/MPA cohort, avacopan was commonly used in patients with severe renal involvement. Most users discontinued GC by month 5, achieved CR, and had favorable renal outcomes.

Funding

• Commercial Support – Amgen