Case 3: Results/Discussion
In this video, Craig Gordon, MD, nephrologist at Tufts Medical Center and associate professor of medicine at Tufts University School of Medicine, reveals the chosen therapy and discusses the results of this case of ANCA-associated vasculitis:
Editor’s note: The following is an automatically generated transcript of the above video.
“So what happened with our patients? So she completed her three day course of IV methylprednisolone and started prednisone 60. Within a few days after discharge from the hospital, she received a gram of rituximab and 14 days later a second gram never was treated with plasma exchange. There were a series of discussions of about the relative benefits of avacopan versus prednisone and opted to be treated with avacopan 30 milligrams twice daily, started about 12 days after discharge after some efforts made to secure the medication. Avacopan was selected partially because of the concern for infections, but if you remember earlier in the presentation the patient also had osteopenia at baseline and so this was sort of a dual reason and perhaps even the GERD would be a third reason to favor less exposure to steroids. That said, in clinical practice it's hard to avoid steroids altogether, and she was on discharge on prednisone because we hadn't obtained the avacopan yet. But once it was approved, the steroids were tapered quite quickly.
Thankfully, it was a good outcome. Her vasculitis symptoms improved over the next few months and her BVAs score returned to essentially normal. Her creatinine also improved to an excellent value of 1.2, and this was a fairly good GFR in her. And she is now still on rituximab therapy for maintenance as we speak with a plan to complete a few years of this. So with that, I think I'll close and I appreciate everyone's attention. Thank you.”