The Canadian Vasculitis Research Network (CanVasc) has updated its consensus recommendations for the use of avacopan in patients with antineutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV).
The guidelines, published in Rheumatology, are based on data confirming that avacopan is an effective steroid-sparing therapy for microscopic polyangiitis and granulomatosis with polyangiitis.
“Prospective studies published between 2017 and 2021 showed that avacopan was an effective and safe steroid-sparing agent for the induction of remission of AAV,” the authors wrote. “The current addended recommendations . . . aim to provide guidance on the role of avacopan in the contemporary therapeutic arsenal of AAV within the Canadian healthcare context, based on the most current available evidence.”
Avacopan, marketed as Tavneos®, is a new oral small molecule compound designed to selectively block the C5 receptor of complement anaphylatoxin C5a on the surface of neutrophils. Studies have demonstrated its ability to induce remission in patients with AAV. It was approved by the US Food and Drug Administration (FDA) in 2021 and by Health Canada in April 2022.
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The research team conducted an updated systematic literature review on avacopan-related publications up to September 2022. As was done for prior CanVasc recommendations, new recommendations were developed based on a modified Delphi procedure to reach at least an 80% consensus on each.
Three new recommendations were added, on indications and duration of avacopan treatment and on glucocorticoid tapering.
The first is that 30 mg twice daily avacopan can be employed to induce remission in patients currently on treatment with cyclophosphamide or rituximab for granulomatosis with polyangiitis or microscopic polyangiitis. The second recommendation is that faster glucocorticoid tapering should be achieved by the end of week 4 of treatment if possible, and the third is that when avacopan is used as induction therapy, its use can be maintained for 1 year.
The authors note that further studies are still needed to determine the optimal use and cost-effectiveness of avacopan and its interactions with other treatments and in other clinical settings.
CanVasc consensus recommendations for the use of avacopan in antineutrophil cytoplasm antibody-associated vasculitis: 2022 addendum. Rheumatology (Oxford). Published online February 21, 2023. doi.10.1093/rheumatology/kead087