1.1 Avacopan with a cyclophosphamide or rituximab regimen is recommended, within its marketing authorisation, as an option for treating severe active granulomatosis with polyangiitis or microscopic polyangiitis in adults. It is recommended only if the company provides it according to the commercial arrangement.
Why the committee made these recommendations
Standard care for granulomatosis with polyangiitis or microscopic polyangiitis usually starts with cyclophosphamide or rituximab, followed by maintenance treatment, usually with azathioprine or rituximab. Corticosteroids are also used throughout treatment. Avacopan is an option to be used alongside this standard care.
Evidence from a clinical trial shows that, after a year, avacopan with standard care is more effective at stopping the conditions getting worse than standard care alone. It also suggests that using avacopan with standard care results in less toxicity from corticosteroids, possibly because of less use overall.
The cost-effectiveness estimates for avacopan with standard care compared with standard care alone are within the range that NICE considers a cost-effective use of NHS resources. So, avacopan with a cyclophosphamide or rituximab regimen is recommended.