Abstract Background/Aims Avacopan is an oral C5a receptor inhibitor that was approved for the treatment of severe active granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) following the pivotal ADVOCATE trial, which demonstrated non-inferiority to glucocorticoid-based regimens and a reduced treatment burden. NICE recommended avacopan for routine commissioning in September 2022. As a first-in-class therapy, uptake in routine clinical practice is expected to vary according to local experience and specialist expertise. Understanding early national prescribing patterns may inform strategies to promote equitable access to advanced vasculitis therapies. Methods Secondary care prescribing data were obtained from OpenPrescribingHospitals.net, covering the period from September 2022 to July 2025. This platform uses data from the Secondary Care Medicines Data (SCMD), which represents pharmacy stock control information from all NHS Trusts in England. Monthly prescription volumes were calculated per patient-months and analysed nationally, regionally, and by integrated care board (ICB). Regional prescribing was standardised per 100,000 population using data from the Office for National Statistics (ONS). Temporal trends and inter-regional variation were explored descriptively. Prescribing by ICB excluded NHS Trusts that were mental health, paediatric, community, or specialist hospitals (e.g. oncology or ophthalmology centres). Associations between prescribing volume and ADVOCATE trial investigator participation were assessed using rank-sum statistical testing. Results Between September 2022 and July 2025, 2.9 million avacopan capsules were prescribed in England, corresponding to approximately 16,000 patient-months of treatment (assuming a 60 mg daily dose). National prescribing increased steadily following NICE approval, peaking in October 2024, when approximately 1,127 patients were treated that month. Four monthly data points for South West England were identified as outliers, with markedly higher values than all other regions and time points (four-fold greater than the interquartile range) and were excluded from regional analyses. London consistently demonstrated the highest prescribing rates per 100,000 population. Marked regional variation was observed: more than half of all avacopan prescriptions originated from the top ten ICBs, with Imperial College Healthcare NHS Trust alone accounting for over 10% of the national total. ICBs with an ADVOCATE trial investigator prescribed significantly higher volumes of avacopan (median 332.5 patient-months IQR 216.1-567.2 vs. 11.1 patient-months IQR 0-58.3, p value 0.01), suggesting that clinician familiarity and local research engagement influence adoption. While the overall trend demonstrates increasing utilisation, several large ICBs showed persistently low prescribing throughout the study period, indicating unequal implementation across England. Conclusion Since its introduction, avacopan prescribing in England has risen markedly, reflecting gradual incorporation into specialist vasculitis services. However, substantial regional variation persists, likely influenced by differences in clinician experience, commissioning pathways, and local access to expert centres. Targeted education, dissemination of prescribing guidance, and shared clinical networks may help ensure equitable adoption of novel therapies for ANCA-associated vasculitis across the NHS. Disclosure K. Biddle: None. Y. Lim: None. C. Chan: None. M. Russell: None. K. Bechman: None. A. Mahto: None. J. Galloway: None.
Biddle et al. (Wed,) studied this question.