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Vasculitic Neuropathy — RACP Adult Medicine MCQ

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HardNeurologyVasculitic NeuropathyRACP Adult Medicine

A patient with newly diagnosed severe granulomatosis with polyangiitis is offered avacopan to minimise cumulative glucocorticoid exposure. How should avacopan be incorporated into induction?

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Correct answer: C — Combine avacopan with rituximab or cyclophosphamide induction for remission

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

B is correct. Avacopan is a C5a-receptor antagonist used with rituximab- or cyclophosphamide-based induction and can reduce glucocorticoid exposure. C provides inadequate induction. D defeats its steroid-sparing purpose and is not universal. E misclassifies its indication. A contradicts the clinical and regulatory context for ANCA-associated vasculitis.

Reference: Australian Prescriber, Avacopan for ANCA-associated vasculitis: https://australianprescriber.tg.org.au/articles/avacopan-for-antineutrophil-cytoplasmic-antibody%E2%80%93associated-vasculitis.html