Avacopan for the Treatment of Anti-Neutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis

OBJECTIVE

To review the safety and efficacy of avacopan for the treatment of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis.

DATA SOURCES

A systematic review of the literature was performed using the terms avacopan OR tavneos OR CCX168 OR ANCA-associated vasculitis in PubMed and Google Scholar. Articles between January 2016 and January 2023 were considered for inclusion. Bibliographies and ClinicalTrials.gov were also searched for completion.

STUDY SELECTION AND DATA EXTRACTION

Relative English language and human studies related to pharmacology, clinical trials, and safety were included.

DATA SYNTHESIS

The 52-week ADVOCATE and 12-week CLEAR clinical trials evaluated the safety and efficacy of avacopan. The remission rate was 65.7% and 54.9% in the avacopan and placebo group, respectively, in the ADVOCATE trial. The Birmingham Vasculitis Activity Score improved by ≥50% in 86.4% of avacopan treated patients and 70% of prednisone treated patients in the CLEAR trial.

RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON WITH EXISTING DRUGS

Glucocorticoids in combination with cyclophosphamide, azathioprine, and/or rituximab have been a mainstay of ANCA-associated vasculitis treatment. However, short- and long-term medication-related adverse effects risk negative outcomes for patients. Avacopan may provide equivalent to better treatment with fewer side effects due to a reduction, if not elimination, of glucocorticoids.

CONCLUSIONS

Avacopan used in isolation or combination is safe and effective for ANCA-associated vasculitis.

Tretinoin 0.1% and Benzoyl Peroxide 3% Cream for the Treatment of Facial Acne Vulgaris

OBJECTIVE

To assess the efficacy, safety, and clinical application of tretinoin 0.1%-benzoyl peroxide 3% cream for the topical treatment of acne vulgaris.

DATA SOURCES

A systematic review of the literature was performed using the terms Twyneo OR tretinoin and benzoyl peroxide OR S6G5T-3 in MEDLINE (PubMed) and EMBASE. ClinicalTrials.gov was searched to obtain completed clinical trial results not published elsewhere.

STUDY SELECTION AND DATA EXTRACTION

All human studies published in English prior to November 2022 related to pharmacology, clinical trials, safety, and efficacy were evaluated for inclusion.

DATA SYNTHESIS

In two 12-week, phase 3, randomized, vehicle-controlled clinical trials, tretinoin 0.1%-benzoyl peroxide 3% cream significantly reduced inflammatory and noninflammatory facial acne lesions and significantly improved Investigator Global Assessment (IGA) rating to clear or almost clear. The cream has a suitable safety profile, with application site pain and dryness as the most common adverse events.

RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON TO EXISTING AGENTS

Tretinoin-BPO had similar IGA success compared to other topical retinoid and retinoid-BPO treatments for acne vulgaris. Compared to individual tretinoin and benzoyl peroxide therapy, the combination product streamlines application, which will improve medication adherence; however, the cost of tretinoin-BPO cream may be prohibitive.

CONCLUSIONS

Tretinoin 0.1%-benzoyl peroxide 3% cream is safe and effective for the treatment of moderate-to-severe acne. Long-term trial data on efficacy and tolerability are not yet available.

Physician Path to Wellness. A Qualitative Investigation of Self-Reported Strategies to Shift from Detrimental Health to Optimal Wellness

Background: A healthy physician performs better clinically and provides superior care to patients than a physician struggling with burnout.

Objective: The purpose of this study is to assess the physician perception of “health” and “burnout,” to identify successful wellness-promoting behaviors, and to build a model characterizing the successful transition from poor health to wellness.

Methods: Utilizing a qualitative approach, the team conducted one-on-one, in-depth, semi-structured interviews with physicians from different specialties. Questions focused on behaviors, beliefs, and system changes that facilitated their transition from poor health/burnout to wellness. Interviews were recorded and responses qualitatively coded from a set of definitions of wellness and burnout. These coded responses were quantified, and code prevalence was analyzed.

Results: Fourteen physicians completed interviews. The codebook consisted of 74 total themes, with nine occurring in more than 10 (71%) of the interviews. Most themes yielded to categories of Wellness, Unwell, and Burnout, with several themes related to individual agency in facilitating wellness. Highly prevalent themes included support systems, nutrition, exercise, and cognitive health. Subjects generally described comprehensive approaches to successfully transitioning to wellness.

Conclusion: This study describes strategies for the successful transition to wellness: physician-level factors such as a healthy support system, maintaining a healthy lifestyle, and developing consistent daily routines. These findings support the importance of physician autonomy and individual-level wellness-promoting strategies for a physician’s transition to wellness. More research should investigate the overall effect of individual-level strategies versus system-level interventions.