A NEW study has revealed that drug-induced liver injury (DILI) is a significant risk for Japanese patients receiving avacopan therapy for ANCA-associated vasculitis (AAV), highlighting the importance of careful monitoring during treatment.
The study examined 22 patients treated with avacopan across multiple centres in Japan between September 2021 and March 2024. DILI was observed in 40.9% of patients, with severe cases involving elevated total bilirubin levels occurring in 44.4% of those affected. While most patients with liver injury recovered after discontinuing avacopan and other medications, one patient developed vanishing bile duct syndrome, which proved fatal.
The study identified three patterns of liver injury ranging from short-term mild injury to severe decompensated cases. Risk factors for severe DILI included older age, lower body weight, and early onset of liver injury soon after the initiation of avacopan treatment.
The findings emphasise the need for frequent liver function monitoring, particularly in vulnerable patients such as the elderly and those with lower body mass index. The authors caution that although avacopan is effective for remission induction in AAV, clinicians must remain vigilant for potential liver complications to ensure early detection and timely intervention.
Aleksandra Zurowska, EMJ
Reference
Kentaro Mori et al. Drug-induced liver injury related to avacopan therapy. Rheumatology. 2024;DOI: 10.1093/rheumatology/keae689.
