Evidence map›Paper›PMID 39849229›Full record

ArticleCEN case reports2025

Successful use of avacopan in a case of ANCA-associated vasculitis with treatment-resistant medium-sized vessel involvement.

Takaaki Tsuchiya, Yui Ohta, Masatoshi Oka, Kaoruko Fukushima, Shiho Matsuno, Noriko Yamanaka, Noriyuki Suzuki, Wako Yumura, Akiko Komatsu, Tomio Arai and 2 more

Abstract readCase Reports
PubMed Full text at PMC Publisher
In one paragraph

Article in CEN case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Making use of avacopan in clinical practice.Clinical kidney journal · 2026
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Takaaki TsuchiyaDepartment of Nephrology and Dialysis, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-Cho, Itabashi, Tokyo, 173-0015, Japan.
Yui OhtaDepartment of Nephrology and Dialysis, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-Cho, Itabashi, Tokyo, 173-0015, Japan.
Masatoshi OkaDepartment of Nephrology and Dialysis, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-Cho, Itabashi, Tokyo, 173-0015, Japan.
Kaoruko FukushimaDepartment of Nephrology and Dialysis, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-Cho, Itabashi, Tokyo, 173-0015, Japan.
Shiho MatsunoDepartment of Nephrology and Dialysis, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-Cho, Itabashi, Tokyo, 173-0015, Japan.
Noriko YamanakaDepartment of Nephrology and Dialysis, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-Cho, Itabashi, Tokyo, 173-0015, Japan.
Noriyuki SuzukiDepartment of Nephrology and Dialysis, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-Cho, Itabashi, Tokyo, 173-0015, Japan.
Wako YumuraDivision of Nephrology and Endocrinology, Tohoku Medical and Pharmaceutical University Hospital, Miyagi, Japan.
Akiko KomatsuDepartment of Pathology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
Tomio AraiDepartment of Pathology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
Takashi TakeiDepartment of Nephrology and Dialysis, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-Cho, Itabashi, Tokyo, 173-0015, Japan.
Mitsuyo ItabashiDepartment of Nephrology and Dialysis, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-Cho, Itabashi, Tokyo, 173-0015, Japan. mitsuyo_itabashi@tmghig.jp.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

We report the case of a 75-year-old woman who presented with fever, right back pain, paresthesia in the right extremities, erythema, purpura, and nodules. She had previously initiated dialysis due to rapidly progressive glomerulonephritis and was transferred to our hospital. Imaging studies revealed multiple cerebral and splenic infarcts and hemorrhage encapsulating the right kidney, likely due to microaneurysms in multiple renal arteries. High MPO-ANCA titers were observed, and a skin biopsy revealed granulomatous inflammation affecting medium-sized vessels, leading to a diagnosis of granulomatosis with polyangiitis (GPA) and ANCA-associated vasculitis (AAV) involving medium-sized vessels. Treatment began with intravenous pulse steroid therapy (methylprednisolone 1000 mg/day) and subsequent oral prednisolone (PSL) 40 mg (about 0.8 mg/kg) and intravenous cyclophosphamide (IVCY) at 250 mg. While her symptoms improved, she developed severe infections, including candidemia and febrile neutropenia. Consequently, we combined PSL with the C5a receptor antagonist avacopan, which allowed for PSL tapering and stabilized her disease. This case is significant as no previous reports of avacopan's efficacy in AAV with medium-sized vessel involvement suggest its potential effectiveness in such cases.

Indexed as

Anti-Neutrophil Cytoplasmic Antibody-Associated VasculitisGranulomatosis with PolyangiitisAgedAntibodies, Antineutrophil CytoplasmicCyclophosphamideFemaleHumansImmunosuppressive AgentsMethylprednisolonePrednisoloneTreatment OutcomeAntibodies, Antineutrophil CytoplasmicCyclophosphamideImmunosuppressive AgentsMethylprednisolonePrednisoloneANCA-associated vasculitis with medium-sized vessel involvementAvacopanGranulomatosis with polyangiitisMicroaneurysms in renal arteries

Identifiers

PMID39849229
PMCPMC12307840

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.