Substitute Biruk Belachew salvaged a draw for the visitors seven minutes from time, cancelling out Fiston Mayele’s early opener.
Both legs are being played in Cairo after the Confederation of African Football (CAF) and the Ethiopian club agreed to stage the fixtures at the Air Defence Stadium in Cairo.
The defending champions, took the lead when Congolese striker Mayele converted a close-range effort from a fine cross by Moroccan midfielder Walid El Karti.
They were forced into an early change when winger Mostafa Fathi limped off with a hamstring injury in the 19th minute and was replaced by Mahmoud Zalaka.
Despite dominating possession, Pyramids failed to add a second goal, with Ethiopian Insurance goalkeeper producing several saves to keep his side in contention.
Belachew struck in the 83rd minute after a quick counterattack, firing a well-placed shot from the edge of the area to level the score.
In stoppage time, Ahmed Sami and Marwan Hamdi both missed clear chances to seal the win as the visitors’ goalkeeper continued his impressive display.
The return leg will also take place at the Air Defence Stadium on Thursday, with a goalless draw enough to send Pyramids through to the group stage.
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