This study conducted a multicenter retrospective analysis of 92 patients with antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) who received avacopan therapy. The primary outcomes were clinical remission at 26 and 52 weeks. Key findings include: 1. **High Remission Rates**: Clinical remission was achieved in 90% of patients at week 26 and 84% at week 52. 2. **Acceptable Safety Profile**: Common reasons for discontinuation included elevated serum aminotransferases and gastrointestinal-related side effects. 3. **Real-World Use**: Avacopan was used in populations excluded from the ADVOCATE trial, including those with advanced kidney disease, kidney replacement therapy, and patients receiving plasma exchange (PLEX). 4. **Diverse Steroid Use**: There was a wide variation in steroid use, with 64% of patients receiving pulse methylprednisolone and a mean cumulative oral prednisone dose of 2.2 mg by week 52. 5. **Delays in Avacopan Initiation**: The median time to start avacopan was 3.6 weeks, and the median time to discontinue prednisone after starting avacopan was 5.6 weeks. The study highlights the effectiveness and safety of avacopan in treating AAV, particularly in real-world settings, and provides insights into the use of avacopan in previously understudied patient populations.This study conducted a multicenter retrospective analysis of 92 patients with antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) who received avacopan therapy. The primary outcomes were clinical remission at 26 and 52 weeks. Key findings include: 1. **High Remission Rates**: Clinical remission was achieved in 90% of patients at week 26 and 84% at week 52. 2. **Acceptable Safety Profile**: Common reasons for discontinuation included elevated serum aminotransferases and gastrointestinal-related side effects. 3. **Real-World Use**: Avacopan was used in populations excluded from the ADVOCATE trial, including those with advanced kidney disease, kidney replacement therapy, and patients receiving plasma exchange (PLEX). 4. **Diverse Steroid Use**: There was a wide variation in steroid use, with 64% of patients receiving pulse methylprednisolone and a mean cumulative oral prednisone dose of 2.2 mg by week 52. 5. **Delays in Avacopan Initiation**: The median time to start avacopan was 3.6 weeks, and the median time to discontinue prednisone after starting avacopan was 5.6 weeks. The study highlights the effectiveness and safety of avacopan in treating AAV, particularly in real-world settings, and provides insights into the use of avacopan in previously understudied patient populations.