Avacopan shows high remission rates in real-world vasculitis care in Northern Ireland

Patients with severe ANCA-associated vasculitis treated with avacopan in routine care across Northern Ireland achieved high remission rates and improved kidney function, according to a retrospective multicentre cohort study published in BMC Rheumatology.

In the ADVOCATE randomised trial, the drug demonstrated improved remission and renal outcomes. However, evidence from routine clinical practice had remained limited, particularly in the United Kingdom and among patients with advanced kidney disease, prompting the new analysis.

The researchers identified adults with newly diagnosed or relapsing ANCA-associated vasculitis who received avacopan between March 2023 and July 2025, drawing data from electronic healthcare records. They collected information on demographics, disease phenotype, kidney function, concomitant immunosuppression, glucocorticoid exposure, relapses, adverse events and remission rates.

Forty patients started the drug. Their median age was 61 years, 75% had newly diagnosed disease, and 77.5% had renal involvement. The kidney disease was frequently severe: 30% of patients had an estimated glomerular filtration rate below 15 mL/min/1.73 m², and 15% were already on kidney replacement therapy when treatment began.

Remission was achieved in 65.6% of patients (21 of 32) at week 26 and sustained in 60.0% (15 of 25) at week 52. Mean eGFR increased by 9.6 mL/min/1.73 m² at week 26 and by 10.4 mL/min/1.73 m² at week 52, with the largest gains observed among patients whose baseline kidney function was most impaired, specifically those starting below 30 and below 15 mL/min/1.73 m².

Among the six patients who were dialysis-dependent at presentation, five discontinued kidney replacement therapy and remained dialysis-free at their last follow-up. The authors are careful about this striking observation: because the study had no comparator group, this recovery cannot be causally attributed to avacopan itself.

Timing of treatment also appeared to matter for kidney outcomes. Early initiation of avacopan, within 30 days, was associated with numerically greater renal recovery, although steroid withdrawal was similar regardless of timing.

Safety findings were mixed. Adverse events occurred in 67.5% of patients, with serious infections affecting 10% and transaminitis, or liver enzyme elevation, affecting 15%.

The authors conclude that, in routine practice across Northern Ireland, avacopan used alongside contemporary immunosuppression was associated with high remission rates and improved kidney function, including recovery of dialysis independence in a small subgroup who presented with kidney failure. They position the findings as early real-world outcomes and post-marketing evidence to inform the drug’s effectiveness and safety in clinical practice, particularly amid the uncertainty now surrounding the pivotal controlled-trial evidence.

Subject of Research: Real-world effectiveness and safety of avacopan in ANCA-associated vasculitis in Northern Ireland

Article Title: Real-world avacopan use in ANCA-associated vasculitis: first experiences in Northern Ireland

Article References: Lavery, C., Duncan, J., Hackett, J., O’Hagan, B., Currie, E., Leonard, N., Smyth, J., Graham, J., McCloskey, O., Masengu, A., Hanko, J., Hill, C., Elliott, A., Pendleton, A., Ball, E., Riddell, C., & McClure, M. (2026). Real-world avacopan use in ANCA-associated vasculitis: first experiences in Northern Ireland. BMC Rheumatology. https://doi.org/10.1186/s41927-026-00703-2

Image Credits: AI Generated

DOI: 10.1186/s41927-026-00703-2

Keywords: avacopan, ANCA-associated vasculitis, C5a receptor inhibitor, kidney function, remission, glucocorticoids, dialysis independence, real-world evidence, BMC Rheumatology, Northern Ireland, adverse events, eGFR