EVIDENCE FOR RENAL RECOVERY WITH AVACOPAN IN ANCA-ASSOCIATED VASCULITIS AND POTENTIAL IMPLICATIONS FOR HEALTHCARE RESOURCE UTILIZATION
Author(s)
Antonio Ramirez de Arellano Serna, MSc, DPhil1, Rachel Cummings, BA, MA, MSc2, Alice Minghetti, PhD3, William Valentine, PhD4.
1CSL Vifor, Glattbrugg, Switzerland, 2CSL Vifor, Staines-Upon-Thames, United Kingdom, 3Ossian Health Economics and Communications, Basel, Switzerland, 4Director, Ossian Health Economics and Communications, Basel, Switzerland.
1CSL Vifor, Glattbrugg, Switzerland, 2CSL Vifor, Staines-Upon-Thames, United Kingdom, 3Ossian Health Economics and Communications, Basel, Switzerland, 4Director, Ossian Health Economics and Communications, Basel, Switzerland.
OBJECTIVES: Renal involvement in ANCA-associated vasculitis (AAV) is associated with progression to end-stage renal disease (ESRD), dialysis, hospitalization, glucocorticoid (GC)-related complications and drives a substantial healthcare burden. A literature review was conducted to evaluate outcomes associated with rituximab (RTX)- and/or avacopan-based regimens during maintenance therapy in patients with AAV.
METHODS: PubMed, EMBASE and the Cochrane Library were searched to identify studies evaluating RTX- and/or avacopan-based therapy in patients with AAV. Eligible studies reported renal outcomes, relapse, hospitalization, or GC-related complications. Outcomes were summarized descriptively, with a focus on renal endpoints, including estimated glomerular filtration rate (eGFR), ESRD and GC exposure.
RESULTS: Among 18 identified RTX-based maintenance studies, reporting focused predominantly on relapse-related outcomes with limited evaluation of renal endpoints. Comparable renal outcomes with RTX- and cyclophosphamide/GC-based comparator regimens were reported. Whilst long-term evidence was more limited for avacopan, a post-hoc analysis of phase 3 trial data has shown that avacopan-based maintenance was associated with an eGFR increase of 16.1 versus 7.7 mL/min/1.73m² with prednisone-based therapy after one year in patients with renal impairment (baseline eGFR ≤20 mL/min/1.73m²). Approximately 41% of avacopan-treated patients achieved a ≥2-fold increase in eGFR versus 13% of prednisone-treated patients, as well as lower GC exposure and fewer GC-related adverse events. Real-world evidence also demonstrated consistent patterns of renal stabilization or improvement, reduced proteinuria and GC exposure, and effectiveness in severe or refractory populations, although studies were limited by observational designs and small sample sizes.
CONCLUSIONS: Available evidence suggests that renal outcomes were comparable with RTX and cyclophosphamide/GC-based regimens, but avacopan-based therapy may support improved renal recovery and reduced GC exposure, particularly among those with impaired renal function. These findings may have implications for healthcare resource utilization and payer decision-making, and support further evaluation of renal endpoints as clinically and economically relevant outcomes in long-term AAV management.
METHODS: PubMed, EMBASE and the Cochrane Library were searched to identify studies evaluating RTX- and/or avacopan-based therapy in patients with AAV. Eligible studies reported renal outcomes, relapse, hospitalization, or GC-related complications. Outcomes were summarized descriptively, with a focus on renal endpoints, including estimated glomerular filtration rate (eGFR), ESRD and GC exposure.
RESULTS: Among 18 identified RTX-based maintenance studies, reporting focused predominantly on relapse-related outcomes with limited evaluation of renal endpoints. Comparable renal outcomes with RTX- and cyclophosphamide/GC-based comparator regimens were reported. Whilst long-term evidence was more limited for avacopan, a post-hoc analysis of phase 3 trial data has shown that avacopan-based maintenance was associated with an eGFR increase of 16.1 versus 7.7 mL/min/1.73m² with prednisone-based therapy after one year in patients with renal impairment (baseline eGFR ≤20 mL/min/1.73m²). Approximately 41% of avacopan-treated patients achieved a ≥2-fold increase in eGFR versus 13% of prednisone-treated patients, as well as lower GC exposure and fewer GC-related adverse events. Real-world evidence also demonstrated consistent patterns of renal stabilization or improvement, reduced proteinuria and GC exposure, and effectiveness in severe or refractory populations, although studies were limited by observational designs and small sample sizes.
CONCLUSIONS: Available evidence suggests that renal outcomes were comparable with RTX and cyclophosphamide/GC-based regimens, but avacopan-based therapy may support improved renal recovery and reduced GC exposure, particularly among those with impaired renal function. These findings may have implications for healthcare resource utilization and payer decision-making, and support further evaluation of renal endpoints as clinically and economically relevant outcomes in long-term AAV management.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
CO136
Topic
Clinical Outcomes, Health Policy & Regulatory, Health Service Delivery & Process of Care
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)