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Standard remission induction therapy combines high-dose glucocorticoids (GCs) with cyclophosphamide or rituximab. While effective, cumulative GC exposure drives substantial treatment-related morbidity, including infection, diabetes, osteoporosis and cardiovascular complications, highlighting the urgent need for GC-sparing strategies. Avacopan, an oral selective C5a receptor antagonist, represents a novel therapeutic approach targeting the alternative complement pathway, a key mediator of neutrophil activation and vascular injury in AAV. The pivotal phase 3 ADVOCATE trial demonstrated that avacopan achieved non-inferior remission at 26\u00a0weeks and superior sustained remission at 52\u00a0weeks compared with a standard GC taper, while reducing GC-related toxicity and improving renal recovery, particularly in patients with advanced kidney impairment. Since approval in 2021, real-world studies and case series have given further confidence in avacopan\u2019s efficacy across diverse patient subgroups, including those with severe renal disease, diffuse alveolar haemorrhage and refractory manifestations. However, real-world data also highlight variability in GC tapering practices and safety signals, particularly hepatotoxicity in Japanese cohorts. Several unanswered questions remain, including the long-term safety, clinical benefit of treatment beyond 1\u00a0year and optimal GC concomitant use or even the feasibility of complete GC avoidance. Ongoing large-scale studies and international real-world evidence will be essential to define avacopan\u2019s optimal role in clinical practice, ensuring equitable access for patients with AAV.<\/jats:p>","DOI":"10.1093\/ckj\/sfaf388","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T12:37:41Z","timestamp":1765197461000},"source":"Crossref","is-referenced-by-count":4,"title":["Making use of avacopan in clinical practice"],"prefix":"10.1093","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0633-3225","authenticated-orcid":false,"given":"Chi Peng","family":"Chan","sequence":"first","affiliation":[{"name":"Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust Department of Renal Medicine, , Birmingham ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azm Ul","family":"Hussain","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust Department of Renal Medicine, , Birmingham ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5001-7500","authenticated-orcid":false,"given":"Dimitrios","family":"Chanouzas","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust Department of Renal Medicine, , Birmingham ,","place":["UK"]},{"name":"University of Birmingham Department of Immunology and Immunotherapy, , Birmingham ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1343-9234","authenticated-orcid":false,"given":"Lorraine","family":"Harper","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust Department of Renal Medicine, , Birmingham ,","place":["UK"]},{"name":"University of Birmingham Department of Applied Health Sciences, , Birmingham ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,12,9]]},"reference":[{"key":"2026012203273979200_bib1","doi-asserted-by":"publisher","first-page":"488","DOI":"10.7326\/0003-4819-116-6-488","article-title":"Wegener granulomatosis: an analysis of 158 patients","volume":"116","author":"Hoffman","year":"1992","journal-title":"Ann Intern Med"},{"key":"2026012203273979200_bib2","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1002\/art.1780370206","article-title":"Nomenclature of systemic vasculitides. 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