Naomi Patel, MD, MPH, Rheumatologist at Massachusetts General Hospital, discusses long-term data from the AQUARIUS study of avacopan in patients with granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA).
GPA is a type of vasculitis causing swelling of the blood vessels anywhere in the body. The condition mainly impacts the sinuses, nose, trachea, lungs, and kidneys. The swelling can limit the flow of blood to these body parts, causing damage. Symptoms of the disease can include sinus pain, recurrent respiratory infections, joint pain, fatigue, and skin lesions. The exact cause of GPA is unknown, but it is a type of autoimmune disease. MPA is also a type of vasculitis. The kidneys, lungs, nerves, skin, and joints are the most commonly affected areas of the body. The cause of this disorder is unknown.
Avacopan is a selective oral C5a receptor antagonist that was approved by the U.S. Food and Drug Administration (FDA) for the treatment of GPA/MPA in 2021. Data was recently presented at ACR and Kidney Week (ASN) from the AQUARIUS clinical trial of avacopan in patients with GPA/MPA.
Data From ACR Presentation (AQUARIUS Part 1) One-Year Real-World Effectiveness with Avacopan in GPA and MPA
This ongoing retrospective cohort study describes 12-month effectiveness and safety outcomes for avacopan in patients with GPA/MPA.
Among the 95 patients with available 12 month follow-up data, 64% were in remission at month 6, while at month 12, 95% had a BVAS v3 equal to zero, 87% were glucocorticoid-free, and 61% had sustained remission. The median discontinuation time was three months and the majority of patients experienced no worsening of glucocorticoid toxicity.
Sustained remission was similar in those with baseline kidney, lung, or ENT involvement. The most common GTI-MD domain with net worsening was blood pressure, followed by body mass index, lipid metabolism, and glucose tolerance. The majority had no net worsening of metabolic GC toxicity over 12 months, indicating either net improvement or no change.
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Data From ASN Presentation of AQUARIUS 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
This is a retrospective cohort study of patients prescribed avacopan for GPA/MPA from December 1, 2021 to April 1, 2024, reporting 12-month outcomes in those with baseline kidney involvement.
Among 58 patients with kidney involvement treated with avacopan, 16% received dialysis less than or equal to 1 month following initiation. Of 54 patients with 12 month follow-up, 69% had sustained remission. Median estimated glomerular filtration rate (eGFR) among those not on dialysis at baseline and 12 months was 35 and 44, respectively. 4% of patients newly initiated dialysis greater than 1 month after avacopan initiation. Of 7 patients on dialysis at baseline with complete follow-up, 86% discontinued dialysis by 12 months. Among those with baseline urine protein:creatinine ratio (UPCR) greater than 2 g/g, median UPCR declined from 1.4 at baseline to 0.3 g/g at 12 months.
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To learn more about GPA/MPA and other rare kidney conditions, visit https://checkrare.com/diseases/kidney-and-urinary-diseases/