Avacopan for the treatment of ANCA-associated vasculitis: an update.
Expert Rev Clin Immunol
; 19(5): 461-471, 2023 05.
Article
in En
| MEDLINE
| ID: mdl-36545762
ABSTRACT
INTRODUCTION:
Glucocorticoids (GC) have been part of the standard treatment of anti-neutrophil cytoplasm autoantibodies (ANCA)-associated vasculitides (AAV) for more than 60 years. Various therapeutic advances have occurred over the past 2 decades and led to a significant reduction of GC exposure, but most patients still have to suffer from complications of GC, including infections, metabolic abnormalities, and cardiovascular morbidity. In 2007, activation of the complement pathway was demonstrated to play a role in the pathogenesis of AAV. Avacopan, an oral competitive inhibitor of the C5a receptor (C5aR1, CD88), was then developed, with an additional aim to decrease the use of GC. AREAS COVERED In this article, we briefly summarize the rationale for targeting the complement pathway in AAV, and review relevant findings from pre-clinical, phase I, II, and III studies, subsequent and more recent case reports and series on the efficacy and safety of avacopan. EXPERT OPINION Based on the results of these studies, avacopan was approved in most countries since late 2021, as an adjunctive induction treatment for patients with AAV. Several newer questions now are pending answers, including as to how avacopan should be used in real-world practice, beyond how it was given in the original clinical trials.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
Type of study:
Risk_factors_studies
Limits:
Humans
Language:
En
Journal:
Expert Rev Clin Immunol
Journal subject:
ALERGIA E IMUNOLOGIA
Year:
2023
Document type:
Article
Affiliation country:
Canadá