Kidney Week

Abstract: SA-OR67

Avacopan beyond the 52-Week Treatment Course

Session Information

• Glomerular Diseases: Clinical Advances
  October 26, 2024 | Location: Room 6D, Convention Center
  Abstract Time: 05:00 PM - 05:10 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Geara, Abdallah Sassine, University of Pennsylvania, Philadelphia, Pennsylvania, United States

Abdallah Sassine Geara, MD

• Ford, Julia, University of Michigan, Ann Arbor, Michigan, United States

Julia Ford, MD

• Geetha, Duvuru, Johns Hopkins University, Baltimore, Maryland, United States

Duvuru Geetha, MD, FASN

Background

The landmark ADVOCATE trial treated patients with AVP for 52 weeks. In real-world use, some patients are prescribed AVP for a longer duration. In this study, we describe a multi-center experience of prolonged courses of AVP including the outcomes at 52w and adverse effects of AVP treatment beyond 52w.

Methods

We performed a multi-center retrospective cohort study of 15 pts with new and relapsing AAV treated with AVP for a duration of 52w or longer.

Results

Mean age 54 (20) years, 53% female, 10/15 MPO-AAV, 5/15 PR3-AAV
4/15 renal involvement and 5/15 relapsing AAV.
RTX induction (12/15) and maintenance (14/15)
All pts discontinued prednisone within the first 26w, mean eGFR rose by 15 and 18 mL/min/1.73m² at 26w and 52w respectively.
Remission was 13/15 at 26w and 15/15 at 52w
Reasons for treating with AVP beyond 52w: physician and/or patient preference in 12/15 pts, inability to give rituximab in 3/15 pts
8/15 stopped AVP after a median duration of 63 (7) w, 7/15 are still taking AVP for a median (IQR) duration of 99 (29) w
Beyond 52w, 3/15 could not be maintained on rituximab
During a mean follow-up period of 96 (21) w, 1/15 patients experienced AAV flare, and none progressed to ESKD.
On last follow-up, the mean eGFR rise from baseline was 16 ml/min/1.73m².
Infections were the most commonly reported adverse effects including 5 infections requiring hospitalization. No patient had to discontinue AVP due to abnormal LFTs during the follow up period.

Conclusion

This real-world experience shows that AVP is being used in real-world practice beyond week 52, with patient/physician preference being the main reason. Rituximab was used alongside AVP for remission maintenance in majority of patients. Infection complications were the most observed adverse effects. Further data on the longer-term use of AVP is needed.