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Case Reports
. 2025 Apr 11;104(15):e42121.
doi: 10.1097/MD.0000000000042121.

Drug-induced liver injury due to avacopan improved by mycophenolate mofetil: A case report

Ryo Yamashita  1 , Yusuke Izumi  1 , Keisuke Takane  1 , Akiyoshi Kinoshita  2 , Jun Hiramoto  1
Affiliations
Case Reports

Drug-induced liver injury due to avacopan improved by mycophenolate mofetil: A case report

Ryo Yamashita et al. Medicine (Baltimore). .

Abstract

Rationale: Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is a systemic necrotizing vasculitis that predominantly affects small vessels. Glucocorticoids are the standard therapeutic agents for AAV; however, their long-term use can cause damage. Avacopan is a small-molecule complement component 5a receptor antagonist that reduces vasculitis and can potentially be used as an alternative to glucocorticoids. However, its therapeutic efficacy remains unknown, and drug-induced liver injury (DILI) is a concern associated with its use.

Patient concerns: A 74-year-old woman with a history of granulomatosis with polyangiitis was admitted to our hospital with a 1-week history of fatigue and anorexia.

Diagnoses: She had started avacopan 3 months before hospitalization. Blood tests showed severe liver injury, and since other diseases were ruled out, she was diagnosed with DILI secondary to avacopan.

Interventions: Avacopan was discontinued, and glucocorticoid doses were increased and ursodeoxycholic acid was administered; however, the liver injury did not resolve. Therefore, mycophenolate mofetil (MMF) was started.

Outcomes: The liver injury was resolved after starting MMF.

Lessons: MMF is effective in treating DILI caused by avacopan.

Keywords: antineutrophil cytoplasmic antibody-associated vasculitis; avacopan; drug-induced liver injury; mycophenolate mofetil.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Clinical course of liver injury due to avacopan. ALP = alkaline phosphatase, ALT = alanine aminotransferase, CRP = C-reactive protein, MMF = mycophenolate mofetil, MPO-ANCA = myeloperoxidase antineutrophil cytoplasmic antibody, PSL = prednisolone, UDCA = ursodeoxycholic acid.
See this image and copyright information in PMC

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