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HCQ with Pre-existing Macular Disease — SCE Rheumatology MCQ

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HardRheumatology PharmacologyHCQ with Pre-existing Macular DiseaseSCE Rheumatology

A patient with MPA receiving avacopan needs lipid therapy after an acute coronary syndrome. Simvastatin 40 mg has been suggested. Which pharmacokinetic fact should change the prescribing discussion?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Use simvastatin SmPC dose limits and toxicity monitoring, or select another statin

Explanation lettering: D = shown as A · E = shown as B · B = shown as D · A = shown as E

D is correct. Avacopan is a moderate CYP3A4 inhibitor in vivo; co-administration increased simvastatin AUC about 3.5-fold and Cmax about 3.2-fold. The simvastatin product information should therefore be used to reduce exposure or choose a suitable alternative. This is a metabolic interaction, not chelation, and dose separation does not neutralise it.

Reference: Avacopan Vifor 10 mg hard capsules SmPC: https://www.medicines.org.uk/emc/product/13744/smpc