Avacopan in AAV — ESENeph MCQ

Correct answer: B — Use avacopan during induction to reduce systemic glucocorticoid exposure

The best answer is “Use avacopan during induction to reduce systemic glucocorticoid exposure”. KDIGO permits avacopan as an alternative glucocorticoid-sparing component of induction, particularly when glucocorticoid toxicity is a major concern; rituximab or cyclophosphamide remains necessary. “Use avacopan with glucocorticoids but without rituximab or cyclophosphamide” is less appropriate because it does not replace remission-induction immunosuppression “Use avacopan as long-term maintenance after standard induction treatment” is less appropriate because its established role is glucocorticoid-sparing during induction “Begin avacopan after irreversible kidney failure has developed” is less appropriate because the decision is driven by induction strategy and toxicity risk “Reserve avacopan for relapse after two conventional induction courses” is less appropriate because KDIGO includes it as a glucocorticoid-sparing option

Reference: KDIGO 2024 ANCA-associated vasculitis guideline: https://kdigo.org/wp-content/uploads/2024/02/KDIGO-2024-ANCA-Vasculitis-Guideline.pdf