Real-World Clinical Outcomes in a Large Health Care System After Avacopan Initiation for Granulomatosis with Polyangiitis (GPA) or Microscopic Polyangiitis (MPA) Involving the Kidneys

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Background: Avacopan is an adjunctive therapy for adults with severe active GPA/MPA. Real-world data on kidney outcomes at 1 year are limited. Methods: In this retrospective cohort study of patients prescribed avacopan for GPA/MPA from 12/1/21-4/1/24 at Mass General Brigham, we report 12-month (mo) outcomes in those with baseline kidney involvement. Data from 12mo pre- to post-avacopan prescription (index date) were extracted by chart review. Sustained remission was defined as Birmingham Vasculitis Activity Score (BVASv3)=0 at 6 and 12mo with no glucocorticoid use for GPA/MPA 1mo prior to 6 and 12mo, and no relapse (1-2 minor items for ≥2 visits, ≥1 major, or ≥3 minor BVAS items) between 6 and 12mo. Kidney-related outcomes included urine protein:creatinine ratio (UPCR), estimated glomerular filtration rate (eGFR), and dialysis. Results: Among 58 avacopan initiators with kidney involvement (mean age 59 years, 60% MPO-ANCA+, 62% MPA, and 88% newly diagnosed), 9 (16%) received dialysis ≤1mo following initiation (Table). Of 54 with 12mo follow-up, 37 (69%) had sustained remission. Median eGFR among those not on dialysis at baseline and 12mo was 35 and 44, respectively. Two (4%) patients newly initiated dialysis >1mo after avacopan initiation. Of 7 patients on dialysis at baseline with complete follow-up, 6 (86%) discontinued dialysis by 12mo. Among those with baseline UPCR >0.2 g/g, median UPCR declined from 1.4 at baseline to 0.3 g/g at 12mo (-71% change). Conclusion: Real-world clinical outcomes with avacopan and improvement in kidney function were consistent with previous clinical trials. Funding: NIDDK Support - NIDDK Support, NIDDK Support

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