VIDEO: Research in ANCA-associated vasculitis may bring a ‘big change in practice’

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I’m a practicing nephrologist at Stanford and my focus is mainly in glomerulonephritis. A big change in practice for managing ANCA-associated vasculitis related to the kidney is our awareness of how complement plays a crucial role in the disease.

So, we know diseases such as lupus or cryoglobulinemia have low complement. We see C3 and C4 are very low and when we do a kidney biopsy, we see immunofluorescent staining with C1 and C1q and C3, and all the staining’s positive, and so we know complement is affected. But in ANCA vasculitis, complements are normal, and the kidney biopsy does not have any staining, and we call it Pauci immune disease because we do not see complement deposition.

But now, we know when this disease, in ANCA-associated vasculitis, we do see that complement is activated. And we have therapies that focus treatment The New England Journal of Medicine from 2021 comparing avacopan (Tavneos, Amgen), which is the C5a inhibitor, to prednisone in 331 patients and found that at 26 weeks, the rates of disease remission in the two groups were the same. But at 52 weeks, there was a sustained remission that was superior, which is really exciting in the avacopan group. And then, in 81 patients in this trial that had renal involvement, we looked at 50 patients that had more significant kidney disease where the GFR was lower than 20, and more patients in the avacopan group had a higher GFR at 52 weeks.

So, we’re really excited that this trial showed us that we can use less steroids and in turn, have less side effects in our patient, and that this drug can be superior in the management of this disease and in remission rates.