Avacopan is associated with high remission rates and low relapse in ANCA-associated vasculitisAvacopan shows high remission rates for ANCA-associated vasculitis

medRxiv Published June 18, 2026 Study authors: Ibiloye, E.; Kathe, N.; Mirkovic, K.; Martin, C.; Tu, S.; Gamburg, R.; Kumar, J.; Solanki, G.; Walla… DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Note that avacopan is associated with high remission rates (93%) and low relapse rates (7%) in ANCA-associated vasculitis.

This systematic review and meta-analysis synthesized evidence from 71 studies regarding the use of avacopan in adult patients with ANCA-associated vasculitis (AAV). The analysis focused on remission rates, relapse, glucocorticoid (GC) usage, and safety outcomes such as hepatotoxicity and infection.

Key findings indicate high remission rates: 87% at 6 months (95% CI: 75%-94%) and 93% at 12 months (95% CI: 86%-97%). Sustained remission at 12 months was reported at 86% (95% CI: 74%-93%), while the relapse rate at 12 months was low at 7% (95% CI: 4%-11%). Additionally, avacopan was associated with a consistent GC sparing effect, with only 36% of patients requiring GC at 6 and 12 months. Renal outcomes included an eGFR improvement of 18 mL/min/1.73 m2 at both 6 and 12 months, and a 66% rate for dialysis liberation.

Safety data indicated that 11% of patients experienced hepatotoxicity and 7% experienced serious infection. The authors noted limitations including heterogeneity in hepatotoxicity reporting and limited comparative effectiveness evidence. These findings suggest avacopan is associated with favorable outcomes in AAV, though its superiority over standard regimens remains unconfirmed due to the lack of direct comparative data.

How this fits prior evidence

This meta-analysis addresses a gap in clinical management for ANCA-associated vasculitis by providing real-world evidence on avacopan. While previous reports noted that ANCA-associated vasculitis is associated with higher mortality and cardiovascular events, this study provides specific efficacy metrics for avacopan, including 93% remission at 12 months and a 66% dialysis liberation rate. It complements the understanding of AAV management by providing data on glucocorticoid sparing (36% use) in this specific population.

Living with ANCA-associated vasculitis means dealing with a serious condition that affects blood vessels. Managing it often requires heavy doses of steroids, which can have tough side effects. New evidence from 71 studies looks at how avacopan performs in everyday clinical practice for adults with this condition.

The data shows strong results for patients using avacopan. About 87% of people reached remission by 6 months, and that number rose to 93% by 12 months. Even more encouragingly, the relapse rate at one year was low, at only 7%. The medication also helped many patients avoid high doses of steroids, with only 36% needing them at the 6 and 12-month marks.

While the results are promising, there are safety points to watch. About 11% of patients experienced some liver issues (hepatotoxicity), and 7% had a serious infection. Because these findings come from real-world practice rather than direct head-to-head trials, it is hard to say exactly how it compares to other standard treatments. Talk to your doctor about how this might fit into your specific care plan.

What this means for you:

Avacopan shows high remission rates and lower steroid use for patients with ANCA-associated vasculitis.

Common questions

How effective is avacopan for my condition?

The data shows that 87% of patients reached remission at 6 months and 93% reached remission at 12 months. Additionally, the rate of relapse at 12 months was low, at only 7%. These figures suggest it is effective for many people with ANCA-associated vasculitis.

Does avacopan help reduce steroid use?

Yes, the findings show a consistent effect in sparing steroids. Only 36% of patients required glucocorticoid (GC) use at both the 6 and 12-month marks when using avacopan.

Are there any side effects to watch out for?

Some safety signals were noted. About 11% of patients experienced some liver issues (hepatotoxicity), and 7% experienced a serious infection. Because of these risks, doctors recommend monitoring your health closely while on this medication.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedJun 2026

View Original Abstract ↓

Background: The efficacy and safety of avacopan in ANCA-associated vasculitis (AAV) has been established in randomized trials of of avacopan as a glucocorticoid (GC) sparing therapy. However, real world evidence (RWE) has an important role in confirming effectiveness and evaluating safety in more generalizable settings. This study aimed to synthesize RWE on the effectiveness and safety of avacopan in adults with AAV. Methods: A systematic literature review and meta analysis of non interventional real world studies was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Eligible studies included adults with AAV treated with avacopan in routine clinical practice. Pooled estimates of effectiveness and safety outcomes were calculated using random effects meta-analyses. Primary outcomes included remission at 6 and 12 months and sustained remission at 12 months. Secondary outcomes included relapse, GC use and dosing, hepatotoxicity, infections, and treatment discontinuation. Exploratory outcomes included changes in estimated glomerular filtration rate (eGFR) and dialysis related endpoints. Results: A total of 71 studies were included and contributed to quantitative analyses. Pooled remission for patients on avacopan was 87% (95% CI: 75%-94%) at 6 months and 93% (95% CI: 86%-97%) at 12 months, and sustained remission was 86% (95% CI: 74%-93%) at 12 months. Relapse at 12 months was low (7%; 95% CI: 4%-11%). GC use was 36% at both 6 and 12 months. Improvements in eGFR were observed at 6 months (18 mL/min/1.73 m2) and 12 months (18 mL/min/1.73 m2), and dialysis liberation was 66% in a limited subset. Among avacopan patients, 11% experienced any hepatotoxicity, including 7% with serious (defined as directly reported or requiring hospitalization) hepatotoxicity, while 7% experienced serious (defined as directly reported or requiring hospitalization) infection. Conclusions: In real world clinical practice, avacopan is associated with high remission rates, low relapse rates, and a consistent GC sparing effect, with effectiveness comparable to standard of care regimens. Findings support its clinical use with appropriate safety monitoring; however, the observed heterogeneity in hepatotoxicity and the limited comparative effectiveness evidence highlight areas requiring further investigation.

Avacopan is associated with high remission rates and low relapse in ANCA-associated vasculitisAvacopan shows high remission rates for ANCA-associated vasculitis

How this fits prior evidence

Common questions

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Avacopan is associated with high remission rates and low relapse in ANCA-associated vasculitisAvacopan shows high remission rates for ANCA-associated vasculitis

How this fits prior evidence

Common questions

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Study Details

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Clinical research that matters. Delivered to your inbox.

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