P016 Audit on the use of avacopan in ANCA-associated vasculitis at a tertiary rheumatology centre

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Abstract Background/Aims Avacopan, a C5a receptor inhibitor, is NICE approved for the treatment of granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). In 2022, EULAR guidelines recommended remission induction of GPA and MPA with rituximab or cyclophosphamide, alongside a reduced-dose regimen of glucocorticoids (GCs) as per the PEXIVAS study. However, no clear consensus exists on GC tapering when avacopan is used concomitantly. UK renal vasculitis centres now routinely halve GC dose at twice the PEXIVAS tapering rate. We aimed to review avacopan use in our centre and its influence on GC tapering in patients with ANCA-associated vasculitis (AAV). Methods This retrospective, observational analysis was conducted on AAV patients who received avacopan at University Hospitals Bristol and Weston (UHBW) between May 2023 and June 2024. Patient notes and laboratory results were reviewed. Efficacy and safety data recorded using a standardised template. GC tapering regimens were compared with both the PEXIVAS protocol and local guidelines (twice the PEXIVAS tapering rate). Results Eight patients with GPA (all PR3-positive) were included (mean age 49.5±24.1 years; 6 males). Two patients (25%) had an ICU admission, requiring mechanical ventilation and renal replacement therapy. All patients had respiratory involvement; 50% experiencing pulmonary haemorrhage. Three patients (37.5%) had renal involvement. Other organs involved included ENT (87.5%), neurological (25%), ocular (25%), cutaneous (37.5%), musculoskeletal (37.5%), cardiovascular (12.5%), and gastroenterology/hepatology (25%). Table 1 reports treatments. At six months, five patients (62.5%) achieved remission (BVAS=0); 80% of these remained on GCs (4-10mg prednisolone daily). Three patients (37.5%) developed infections, one requiring hospitalisation. One patient developed abnormal liver function tests. One patient died from out-of-hospital cardiac arrest. Fifty percent of patients tapered GCs in line with PEXIVAS; none followed the accelerated tapering rate in local guidelines. Conclusion No major safety concerns were identified with avacopan in this small study. Approximately 40% of patients experienced an infection, less than the ADVOCATE trial. Larger real-world cohorts are needed to ensure no rarer safety concerns. GC tapering with avacopan was cautious, likely due to concerns about disease relapse and use of a novel treatment. A patient-specific approach currently seems reasonable when deciding optimal GC tapering strategy. Disclosure J. Kimpton: None. K. Lim: None. E. Davies: None. B. Boyce: None. E. Humphreys: None. R. Marshall: None. E. Perry: None. E. Reilly: None. T. Reynolds: None. M. Roy: None. J. Robson: None.

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