FDA Approves Avacopan for Rare ANCA Autoimmune Disease

US regulators approved avacopan (Tavneos) for a rare immune disorder after receiving additional information to address concerns raised about the drug that were previously discussed at a public meeting in May.

ChemoCentryx Inc, the drug's manufacturer, today announced that the US Food and Drug Administration (FDA) approved the drug as an adjunctive treatment for severe active anti-neutrophil cytoplasmic autoantibody-associated vasculitis (also known as ANCA-associated vasculitis or ANCA vasculitis).

This systemic disease results from overactivation of the complement system, leading to inflammation and eventual destruction of small blood vessels. This can lead to organ damage and failure, with the kidney as the major target, said the company in a statement.

The avacopan approval was based in large part on the results of the ADVOCATE trial, which were highlighted in a February 2021 editorial in the New England Journal of Medicine , titled "Avacopan — Time to Replace Glucocorticoids?" But the FDA-approved indication for avacopan is as an adjunctive treatment of adult patients with severe active ANCA-associated vasculitis (granulomatosis with polyangiitis [GPA] and microscopic polyangiitis [MPA]) in combination with standard therapy including glucocorticoids. "Tavneos does not eliminate glucocorticoid use," the label states.

The ADVOCATE trial was a global, randomized, double-blind, active-controlled, double-dummy phase 3 trial of 330 patients with ANCA-associated vasculitis conducted in 20 countries, ChemoCentryx said. Participants were randomly assigned to receive either rituximab or cyclophosphamide (followed by azathioprine/mycophenolate) and either avacopan or study-supplied oral prednisone.

Subjects in both treatment groups could also receive nonprotocol glucocorticoids as needed. The study met its primary endpoints of disease remission at 26 weeks and sustained remission at 52 weeks, as assessed by the Birmingham Vasculitis Activity Score (BVAS), ChemoCentryx said. Common adverse reactions among study participants included nausea, headache, hypertension, diarrhea, vomiting, rash, fatigue, upper abdominal pain, dizziness, blood creatinine increase, and paresthesia.

In the ChemoCentryx statement, Peter A. Merkel, MD, MPH, a consultant to the company and the chief of rheumatology at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, called the avacopan clearance a "first-in-a-decade approval of a medicine for ANCA-associated vasculitis."

"Patients will now have access to a new class of medication that provides beneficial effects for the treatment of ANCA-associated vasculitis," Merkel said.

In reviewing the avacopan application, the FDA noted that the medicine is intended to treat "a rare and serious disease associated with high morbidity and increased mortality."

"It is also a disease with high unmet need for new therapies," the FDA staff said in a review of ChemoCentryx application for approval of avacopan, which was posted online ahead of a meeting this past May.

Previous FDA Concerns

In that review, FDA staff made public various concerns about the evidence used in seeking approval of the medicine. The FDA staff said there were "substantial uncertainties around the phase 3 study design and results, raising questions about the adequacy of this single trial to inform the benefit–risk assessment."

Members of the FDA's Arthritis Advisory Committee Meeting voted 10-8 on May 6 on a question of whether the risk–benefit profile of avacopan is adequate to support approval. The panel also voted 9-9 on whether the efficacy data support approval of avacopan, and 10-8 that the safety profile of avacopan is adequate to support approval.

ChemoCentryx in July said it filed an amendment to its new drug application (NDA) for avacopan. This appears to have answered regulators' questions about the drug.

On a call with analysts Friday, ChemoCentryx officials outlined a marketing strategy for avacopan, with efforts focused on reaching influential rheumatologists and nephrologists. The company will set a US wholesale acquisition cost for the drug of about $150,000 to $200,000 a patient, in keeping with the range of prices often seen for orphan drugs. ChemoCentryx said it intends to offer financial support programs for the medicine.

ChemoCentryx said avacopan is also approved for the treatment of microscopic polyangiitis and granulomatosis with polyangiitis (the two main forms of ANCA-associated vasculitis) in Japan. The regulatory decision in Europe is expected by the end of this year.

Kerry Dooley Young is a freelance journalist based in Washington, D.C. She is the core topic leader on patient safety issues for the Association of Health Care Journalists. Young earlier covered health policy and the federal budget for Congressional Quarterly/CQ Roll Call and the pharmaceutical industry and the Food and Drug Administration for Bloomberg.  Follow her on Twitter at @kdooleyyoung .

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Cite this: FDA Approves Avacopan for Rare ANCA Autoimmune Disease - Medscape - Oct 08, 2021.