{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T18:30:19Z","timestamp":1789065019973,"version":"build-2803163510"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T00:00:00Z","timestamp":1679875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,19]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:p>Microscopic polyangiitis is a necrotising vasculitis characterised by anti-neutrophil cytoplasmic antibodies against myeloperoxidase. The complement component 5a receptor inhibitor avacopan effectively sustains remission in microscopic polyangiitis with a reduction in prednisolone dosage. Liver damage is a safety concern for this drug. However, when it occurs and how to treat it remain unknown. A 75-year-old man developed microscopic polyangiitis and presented with hearing impairment and proteinuria. Methylprednisolone pulse therapy followed by 30\u2009mg\/day prednisolone and two doses of weekly rituximab were administered. Avacopan was initiated to taper prednisolone for sustained remission. After 9 weeks, liver dysfunction and sparse skin eruptions developed. The cessation of avacopan and the initiation of ursodeoxycholic acid improved liver function without discontinuation of prednisolone and other concomitant drugs. After 3 weeks, avacopan was rechallenged with a small dose that was gradually increased; ursodeoxycholic acid was continued. Full-dose avacopan did not induce recurrence of liver injury. Therefore, gradually increasing the dose of avacopan with concomitant ursodeoxycholic acid use may help avoid possible avacopan-induced liver injury.<\/jats:p>","DOI":"10.1093\/mrcr\/rxad019","type":"journal-article","created":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T17:25:43Z","timestamp":1679937943000},"page":"444-447","source":"Crossref","is-referenced-by-count":21,"title":["Gradual increase of avacopan dose with concomitant ursodeoxycholic acid use may help avoid the risk of C5a receptor inhibitor-induced liver injury in antineutrophil cytoplasmic antibody-associated vasculitis"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2502-8304","authenticated-orcid":false,"given":"Hiroshi","family":"Kataoka","sequence":"first","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, Sapporo City General Hospital , Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoko","family":"Tomita","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, Sapporo City General Hospital , Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mika","family":"Nakanowatari","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, Sapporo City General Hospital , Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Kondo","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, Sapporo City General Hospital , Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaya","family":"Mukai","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Clinical Immunology, Sapporo City General Hospital , Sapporo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,3,27]]},"reference":[{"key":"2023061920014225300_R1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/art.37715","article-title":"2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides","volume":"65","author":"Jennette","year":"2013","journal-title":"Arthritis Rheum"},{"key":"2023061920014225300_R2","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1093\/rheumatology\/keu366","article-title":"Glucocorticoid treatment and damage in the anti-neutrophil cytoplasm antibody-associated vasculitides: long-term data from the European Vasculitis Study Group trials","volume":"54","author":"Robson","year":"2015","journal-title":"Rheumatology (Oxford)"},{"key":"2023061920014225300_R3","doi-asserted-by":"crossref","DOI":"10.1093\/mr\/roac114","article-title":"Systematic review and meta-analysis for 2023 clinical practice guidelines of the Japan Research Committee of the Ministry of Health, Labour, and Welfare for Intractable\u00a0Vasculitis for the management of ANCA-associated vasculitis","author":"Watanabe","year":"2022","journal-title":"Mod Rheumatol"},{"key":"2023061920014225300_R4","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1056\/NEJMoa2023386","article-title":"Avacopan for the treatment of ANCA-associated vasculitis","volume":"384","author":"Jayne","year":"2021","journal-title":"N Engl J Med"},{"key":"2023061920014225300_R5","doi-asserted-by":"crossref","first-page":"2756","DOI":"10.1681\/ASN.2016111179","article-title":"Randomized trial of C5a receptor inhibitor avacopan in ANCA-associated vasculitis","volume":"28","author":"Jayne","year":"2017","journal-title":"J Am Soc Nephrol"},{"key":"2023061920014225300_R6","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1136\/annrheumdis-2021-221796","article-title":"2022 American College of Rheumatology\/European Alliance of Associations for Rheumatology classification criteria for microscopic polyangiitis","volume":"81","author":"Suppiah","year":"2022","journal-title":"Ann Rheum Dis"},{"key":"2023061920014225300_R7","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.1136\/ard.2008.101279","article-title":"Modification and validation of the Birmingham Vasculitis Activity Score (version 3)","volume":"68","author":"Mukhtyar","year":"2009","journal-title":"Ann Rheum Dis"},{"key":"2023061920014225300_R8","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1136\/gutjnl-2016-313369","article-title":"Drug-induced liver injury: recent advances in diagnosis and risk assessment","volume":"66","author":"Kullak-Ublick","year":"2017","journal-title":"Gut"},{"key":"2023061920014225300_R9","doi-asserted-by":"crossref","first-page":"1323","DOI":"10.1016\/0895-4356(93)90101-6","article-title":"Causality assessment of adverse reactions to drugs\u2014I. 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