Enticing New Options In ANCA - Associated Vasculitis - Dr. David Liew Save
Dr. David Liew from EULAR2020
Transcription
Hi, I'm David Lugh reporting for rheumnow.com on this virtual ULA from the comfort of my home here in Melbourne, Australia. It's been fascinating to get used to this idea of the virtual conference, I'd really like to tell you about some breakthrough abstracts that came out at this ULA about Ankara Associated Vasculitis, one about therapy and then one about predicting relapse. Both two important clinical questions in our everyday practice with Ankara Associated Vasculitis. There's been a lot of talk at this meeting, around, social media and in the actual lay media about Avacopan. Avacopan is an agent we've heard, quite a bit about in previous meetings.
It's a C5a receptor inhibitor, inhibiting that element of the complement pathway and affecting that neutrophilic drive which underlies ANCA associated vasculitis. We were lucky enough to see the results of the ADVOCATE trial, the phase three trial in avacopan, in Ankras Osteo Vasculitis, presented by Peter Merkel on the first day of the conference, and subsequently it's going to be, reported on the Sunday at the European Renal Meeting as well by David Jane. So, this looked at patients who were already receiving rituximab or cyclophosphamide for their ANCA associated vasculitis and was a double blinded randomised controlled trial with avacopan versus corticosteroids. That is to say, the avacopan group as protocol didn't have steroids. So head to head replacing that part of therapy.
And it's quite exciting because that's something that we've always wanted to do. The idea of a steroid free regimen in ankylosing osteophasculitis is quite tempting. What we what we saw was that at twenty six weeks, the outcomes were non inferior and the the group that continued on another twenty six weeks to fifty two weeks actually had superior outcomes, in the avacopan group. And not only that, and and of course, you'd expect there to be a lower steroid burden in the avacopan group. You'd expect there to be, wish there was, obviously, that you'd expect there to be lower steroid toxicity, as judged by the glucocorticoid toxicity index that we have now come to, now have become familiar with.
We've seen we saw that lower as well. But we also saw better renal outcomes as well. Better renal function in the Avacopan group versus the, steroid group. This is really quite paradigm changing if we get to use it. This is the kind of thing which might replace our old friend steroids, which we know and love, but at the same time have a bit of self loathing for, and this might actually change things.
Now, of course, it comes down to cost. Corticosteroids are cheap. Avacopan, I suspect, will not be. But if the pricing's right, maybe this is something, which we might see as standard of care in ANCA associated vasculitis. Certainly, there's a lot of positive talk about it.
The second abstract actually comes from an analysis of the main RITSON two study, in ANCA associated vasculitis and looks at the idea of serum calprotectin. Now I think a lot of us are familiar with the idea of fecal calprotectin to try and pick up inflammation or colonic info enteric and colonic inflammation. What I think we're we're perhaps a little bit less familiar with is the idea of serum calprotectin, although it's been talked about a lot at EULA over the years in the context of things like early rheumatoid arthritis. It's a bit more sensitive than the markers, the proof of blood inflammation markers that we're used to thinking about, like ESR and CRP. And that's the idea that maybe we might be able to pick up some of this subclinical inflammation that might predict the future relapses of disease.
And so it's been looked at in, as part of Main Ritz Center. Was collected there. And there's been data looking at early calprotectin predicting future relapse. But what this analysis from French colleagues looked at was actually the idea that serum calprotectin during that maintenance phase might actually predict relapse. And indeed, it did.
It predicted outright relapse and predicted renal function problems as well. So really this was quite an enticing idea that right now a lot of us are following anchor titers, MPO, PI3 titers with the knowledge that they probably don't really predict anything, but that's something that we hold on to. We follow our inflammatory markers dutifully. And then other than that, we're just seeing the flares once they happen. With this, potentially, we might be able to predict those flares as they're about to happen.
And that's an exciting prospect as well. So two potentially game changing abstracts here, at YuleEye twenty twenty, well, virtually at YuleEye twenty twenty. Perhaps we'll see them in our practice in the future. Of course, it does come down to cost. So I'm David Lewin.
For more, go to rheumnow.com.
It's a C5a receptor inhibitor, inhibiting that element of the complement pathway and affecting that neutrophilic drive which underlies ANCA associated vasculitis. We were lucky enough to see the results of the ADVOCATE trial, the phase three trial in avacopan, in Ankras Osteo Vasculitis, presented by Peter Merkel on the first day of the conference, and subsequently it's going to be, reported on the Sunday at the European Renal Meeting as well by David Jane. So, this looked at patients who were already receiving rituximab or cyclophosphamide for their ANCA associated vasculitis and was a double blinded randomised controlled trial with avacopan versus corticosteroids. That is to say, the avacopan group as protocol didn't have steroids. So head to head replacing that part of therapy.
And it's quite exciting because that's something that we've always wanted to do. The idea of a steroid free regimen in ankylosing osteophasculitis is quite tempting. What we what we saw was that at twenty six weeks, the outcomes were non inferior and the the group that continued on another twenty six weeks to fifty two weeks actually had superior outcomes, in the avacopan group. And not only that, and and of course, you'd expect there to be a lower steroid burden in the avacopan group. You'd expect there to be, wish there was, obviously, that you'd expect there to be lower steroid toxicity, as judged by the glucocorticoid toxicity index that we have now come to, now have become familiar with.
We've seen we saw that lower as well. But we also saw better renal outcomes as well. Better renal function in the Avacopan group versus the, steroid group. This is really quite paradigm changing if we get to use it. This is the kind of thing which might replace our old friend steroids, which we know and love, but at the same time have a bit of self loathing for, and this might actually change things.
Now, of course, it comes down to cost. Corticosteroids are cheap. Avacopan, I suspect, will not be. But if the pricing's right, maybe this is something, which we might see as standard of care in ANCA associated vasculitis. Certainly, there's a lot of positive talk about it.
The second abstract actually comes from an analysis of the main RITSON two study, in ANCA associated vasculitis and looks at the idea of serum calprotectin. Now I think a lot of us are familiar with the idea of fecal calprotectin to try and pick up inflammation or colonic info enteric and colonic inflammation. What I think we're we're perhaps a little bit less familiar with is the idea of serum calprotectin, although it's been talked about a lot at EULA over the years in the context of things like early rheumatoid arthritis. It's a bit more sensitive than the markers, the proof of blood inflammation markers that we're used to thinking about, like ESR and CRP. And that's the idea that maybe we might be able to pick up some of this subclinical inflammation that might predict the future relapses of disease.
And so it's been looked at in, as part of Main Ritz Center. Was collected there. And there's been data looking at early calprotectin predicting future relapse. But what this analysis from French colleagues looked at was actually the idea that serum calprotectin during that maintenance phase might actually predict relapse. And indeed, it did.
It predicted outright relapse and predicted renal function problems as well. So really this was quite an enticing idea that right now a lot of us are following anchor titers, MPO, PI3 titers with the knowledge that they probably don't really predict anything, but that's something that we hold on to. We follow our inflammatory markers dutifully. And then other than that, we're just seeing the flares once they happen. With this, potentially, we might be able to predict those flares as they're about to happen.
And that's an exciting prospect as well. So two potentially game changing abstracts here, at YuleEye twenty twenty, well, virtually at YuleEye twenty twenty. Perhaps we'll see them in our practice in the future. Of course, it does come down to cost. So I'm David Lewin.
For more, go to rheumnow.com.
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