December 2025

RHEUMATOLOGY

OUTCOMES AMONG PATIENTS WITH GPA AND MPA ON AVACOPAN

Avacopan, a complement 5a receptor antagonist, was approved by the Food and Drug Administration in 2021 as an adjunctive treatment for granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). While clinical trials demonstrated its efficacy, real-world data from community rheumatology practices have been limited, until now.
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In a recent study published in Annals of the Rheumatic Diseases, Brian Jaros, MD, Anisha Dua, MD, and colleagues share important insights from their findings.

Study Overview
  • Population: 45 patients with GPA or MPA who used avacopan for ≥6 months
  • Median age: 56
  • Female: 69%
  • Diagnosis breakdown:
    • GPA: 64.4%
    • MPA: 22.2%
    • Undefined GPA/MPA: 13.3%
  • Disease status:
    • Relapsing: 51%
    • New: 42%
    • Severe active: 60% (often requiring rituximab or cyclophosphamide)

Key Findings
  • Glucocorticoid (GC) reduction:
    • Median GC dose at initiation: 20 mg/day
    • 71% discontinued GCs within 12 months
    • Remaining patients: median GC dose of 5 mg/day at 12 months
  • Disease control:
    • Over 90% had no disease worsening despite GC reduction
  • Common organ involvement at baseline:
    • Kidney: 44%
    • Chest: 33%
    • Musculoskeletal/constitutional: 33%
    • Ear/nose/throat: 31%

​Clinical Takeaways
  • Avacopan offers a steroid-sparing strategy for treating GPA and MPA in real-world practice
  • Most patients maintained disease control while reducing or eliminating GCs
  • Particularly relevant for patients with severe active disease or those at risk for GC toxicity
​​Anisha B. Dua, MD, Associate Professor of Rheumatology at Northwestern Medicine
Brian D. Jaros, MD, Assistant Professor of Rheumatology and Associate Program Director for the Rheumatology Fellowship at Northwestern Medicine

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