The C5a receptor inhibitor avacopan is as effective as prednisone tapering in treating antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis and might prove superior, trial results suggest.

In the international double-blind and double-dummy controlled ADVOCATE phase 3 trial conducted across 20 countries including Australia, 331 patients were randomised to a tapering prednisone schedule for 20 weeks or avacopan 30mg twice daily for 52 weeks.

The starting prednisone dose varied between 30-60mg/day depending on the patient’s weight and age, and was tapered to zero by week 21, while patients in both trial arms also received immunosuppressive therapy — either cyclophosphamide and azathioprine or rituximab — according to their treating doctor’s choice.

At 26 weeks, 72.3% of patients in the avacopan arm and 70.1% of those in the prednisone arm had achieved remission — defined as a score of zero on the Birmingham Vasculitis Activity Score (BVAS).