Guidelines CanVasc consensus recommendations for the use of avacopan in antineutrophil cytoplasm antibody-associated vasculitis: 2022 addendum David Turgeon 1 *, Volodko Bakowsky 2 , Corisande Baldwin 3 , David A. Cabral 4 , Marie Clements-Baker 5 , Alison Clifford 6 , Jan Willem Cohen Tervaert 6 , Natasha Dehghan 3 , Daniel Ennis 3 , Leilani Famorca 7 , Aurore Fifi-Mah 8 , Louis-Philippe Girard 9 , Fre ´ de ´ ric Lefebvre 10 , Patrick Liang 11 , Jean-Paul Makhzoum 12 , David Massicotte-Azarniouch 13 , Arielle Mendel 14 , Nataliya Milman 15 , Heather N. Reich 16 , David B. Robinson 17 , Carolyn Ross 12 , Dax G. Rumsey 18 , Medha Soowamber 1 , Tanveer E. Towheed 5 , Judith Trudeau 19 , Marinka Twilt 20 , Elaine Yacyshyn 6 , Gozde K. Yardimci 1 , Nader Khalidi 7 , Lillian Barra 21 , Christian Pagnoux 1 1 Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada 2 Division of Rheumatology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada 3 Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada 4 Division of Pediatric Rheumatology, BC Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada 5 Division of Rheumatology, Queen’s University, Kingston, Ontario, Canada 6 Division of Rheumatology, University of Alberta, Edmonton, Alberta, Canada 7 Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada 8 Division of Rheumatology, University of Calgary, Calgary, Alberta, Canada 9 Division of Nephrology, University of Calgary, Calgary, Alberta, Canada 10 Division of Rheumatology, Centre Hospitalier de l’Universite ´ de Montre ´ al, Universite ´ de Montre ´ al, Montre ´ al, Que ´ bec, Canada 11 Division of Rheumatology, Centre Hospitalier Universitaire de Sherbrooke, Universite ´ de Sherbrooke, Sherbrooke, Que ´ bec, Canada 12 Division of Internal Medicine, Ho ˆ pital du Sacre ´ -Coeur de Montre ´ al, Universite ´ de Montre ´ al, Montre ´ al, Que ´ bec, Canada 13 Division of Nephrology, The Ottawa Hospital, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada 14 Division of Rheumatology, McGill University Health Centre, Montre ´ al, Que ´ bec, Canada 15 Division of Rheumatology, The Ottawa Hospital, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada 16 Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada 17 Division of Rheumatology, University of Manitoba, Winnipeg, Manitoba, Canada 18 Division of Pediatric Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada 19 Division of Rheumatology, CISSS Chaudie ` re-Appalaches, Universite ´ Laval, Quebec City, Que ´ bec, Canada 20 Division of Pediatric Rheumatology, Department of Pediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada 21 Division of Rheumatology, Department of Medicine, Western University, London, Ontario, Canada *Correspondence to: David Turgeon, MD, Vasculitis Clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, 60 Murray Street Room 2-226, Toronto, Ontario M5T 3L9, Canada. E-mail: david.turgeon.1@umontreal.ca Abstract Objective: In 2020, the Canadian Vasculitis Research Network (CanVasc) published their updated recommendations for the management of ANCA-associated vasculitides (AAV). The current addendum provides further recommendations regarding the use of avacopan in AAV based on a review of newly available evidence. Methods: An updated systematic literature review on avacopan (formerly, CCX168) using Medline, Embase, and the Cochrane Library was per- formed for publications up to September 2022. New recommendations were developed and categorized according to the EULAR grading levels, as done for previous CanVasc recommendations. A modified Delphi procedure and videoconferences were used to reach 80% consensus on the inclusion, wording and grading of each recommendation. Results: Three new recommendations were developed. They focus on avacopan therapy indication and duration, as well as timely glucocorticoid tapering. Conclusion: These 2022 addended recommendations provide rheumatologists, nephrologists and other specialists caring for patients with AAV with guidance for the use of avacopan, based on current evidence and consensus from Canadian experts. Keywords: ANCA, anti-neutrophil cytoplasm antibody-associated vasculitis, granulomatosis with polyangiitis, microscopic polyangiitis, glomerulonephritis, avacopan Received: 13 December 2022. Accepted: 8 February 2023 V C The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com Rheumatology, 2023, 00, 1–6 https://doi.org/10.1093/rheumatology/kead087 Advance access publication 21 February 2023 Guidelines Rheumatology Downloaded from https://academic.oup.com/rheumatology/advance-article/doi/10.1093/rheumatology/kead087/7049474 by guest on 12 March 2023