The author reviews the available evidence showing the possible role of selective c5a complement receptor inhibition in thetreatment of ANCA-associated vasculitis (AAV). In the randomized, placebo-controlled, phase 2 study (CLEAR), theaddition of avacopan, a new oral C5a receptor inhibitor, to theremission induction treatment with cyclophosphamide or rituximab with or without glucocorticoids in patients with AAV resulted in a higher remission rate at 12 weeks (86% and81%, respectively) compared with that in patients treated with cyclophosphamide or rituximab in combination with high dose glucocorticoids and placebo (70%, р≤0.01). The safety profile of avacopan was favorable. There were no deaths, while the occurence of serious infections was 4-5%. The rate of adverse effects of glucocorticoids in the avacopan groups was lower than in the control group. Additional studies areneeded to evaluate the long-term outcomes of treatment with avacopan as a steroid-sparing agent in patients with AAV.
Аvacopan, CCX168, selective C5a receptor inhibitor, systemic vasculitis, ANCA.