{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T18:30:16Z","timestamp":1789065016504,"version":"build-2803163510"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,11,16]],"date-time":"2024-11-16T00:00:00Z","timestamp":1731715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,16]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:p>Drug-induced liver injury is a major concern associated with the use of avacopan, a new therapeutic agent for antineutrophil cytoplasmic antibody-associated vasculitis. Here, we report a rare instance of liver biopsy performed for persistent liver injury following discontinuation of avacopan in an elderly woman with microscopic polyangiitis. The patient developed cholestatic liver injury after 2\u2009months of avacopan therapy, which led to drug cessation. Despite the discontinuation of avacopan followed by supportive care, the liver enzyme levels remained elevated, necessitating liver biopsy. Histological examination revealed residual inflammation and focal necrosis around the portal vein, indicating ongoing liver injury despite avacopan withdrawal. This case report highlights the hepatotoxic potential of avacopan, the importance of vigilant liver function monitoring, and the value of liver biopsy in the chronic phase of avacopan-induced liver injury. Further research is required to elucidate avacopan hepatotoxicity mechanisms and identify potential risk factors for drug-induced liver injury in patients with antineutrophil cytoplasmic antibody-associated vasculitis.<\/jats:p>","DOI":"10.1093\/mrcr\/rxae071","type":"journal-article","created":{"date-parts":[[2024,11,16]],"date-time":"2024-11-16T08:28:43Z","timestamp":1731745723000},"page":"163-167","source":"Crossref","is-referenced-by-count":11,"title":["Persistent liver injury following avacopan discontinuation in antineutrophil cytoplasmic antibody-associated vasculitis: A rare case of liver biopsy in the chronic phase of liver injury"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9835-8040","authenticated-orcid":false,"given":"Hiroyuki","family":"Yamaguchi","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Funabashi Municipal Medical Center , Funabashi,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nayu","family":"Fujii","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Funabashi Municipal Medical Center , Funabashi,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Funabashi Municipal Medical Center , Funabashi,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,11,16]]},"reference":[{"key":"2025011615465137800_R1","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.1056\/NEJM198806233182504","article-title":"Anti-neutrophil cytoplasmic autoantibodies with specificity for myeloperoxidase in patients with systemic vasculitis and idiopathic necrotizing and crescentic glomerulonephritis","volume":"318","author":"Falk","year":"1988","journal-title":"N Engl J Med"},{"key":"2025011615465137800_R2","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":"2025011615465137800_R3","first-page":"321","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":"Arthritis Rheumatol"},{"key":"2025011615465137800_R4","article-title":"FDA approves add-on drug for adults with rare form of blood vessel inflammation. U.S. Food and Drug Administration","author":"Center for Drug Evaluation","year":"2021"},{"key":"2025011615465137800_R5","doi-asserted-by":"crossref","DOI":"10.1177\/17562848231163410","article-title":"Drug-induced liver injury: a comprehensive review","volume":"16","author":"Hosack","year":"2023","journal-title":"Therap Adv Gastroenterol"},{"key":"2025011615465137800_R6","doi-asserted-by":"crossref","first-page":"e120","DOI":"10.1093\/rheumatology\/kead285","article-title":"A case of vanishing bile duct syndrome during treatment of microscopic polyangiitis with avacopan","volume":"63","author":"Yamaguchi","year":"2024","journal-title":"Rheumatology"},{"key":"2025011615465137800_R7","doi-asserted-by":"crossref","first-page":"e149","DOI":"10.1093\/rheumatology\/kead561","article-title":"Comment on: A case of vanishing bile duct syndrome during treatment of microscopic polyangiitis with avacopan","volume":"63","author":"Shirota","year":"2024","journal-title":"Rheumatology"},{"key":"2025011615465137800_R8","doi-asserted-by":"crossref","first-page":"e101","DOI":"10.1093\/rheumatology\/kead509","article-title":"Severe prolonged liver abnormality with jaundice during treatment for granulomatosis with polyangiitis with rituximab and avacopan","volume":"63","author":"Kojima","year":"2024","journal-title":"Rheumatology"},{"key":"2025011615465137800_R9","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1111\/his.13082","article-title":"The histopathological evaluation of drug-induced liver injury","volume":"70","author":"Kleiner","year":"2017","journal-title":"Histopathology"},{"key":"2025011615465137800_R10","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1093\/mrcr\/rxad019","article-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","volume":"7","author":"Kataoka","year":"2023","journal-title":"Mod Rheumatol Case Rep"}],"container-title":["Modern Rheumatology Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/mrcr\/advance-article-pdf\/doi\/10.1093\/mrcr\/rxae071\/60983321\/rxae071.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mrcr\/article-pdf\/9\/1\/163\/60983321\/rxae071.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mrcr\/article-pdf\/9\/1\/163\/60983321\/rxae071.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T15:53:41Z","timestamp":1737042821000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/mrcr\/article\/9\/1\/163\/7901686"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,16]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,11,16]]},"published-print":{"date-parts":[[2025,1,16]]}},"URL":"https:\/\/doi.org\/10.1093\/mrcr\/rxae071","relation":{},"ISSN":["2472-5625"],"issn-type":[{"value":"2472-5625","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,1]]},"published":{"date-parts":[[2024,11,16]]}}}