Application of C5 inhibitors in glomerular diseases in 2021

• Published in: Kidney research and clinical practice Vol. 41; no. 4; pp. 412 - 421
• Main Authors: Werion, Alexis, Rondeau, Eric
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Nephrology 01-07-2022; 대한신장학회
• Subjects: anca associated vasculitis; c5 inhibitors; complement inhibitors; hemolytic uremic syndrome; kidney diseases; Review; thrombotic microangiopathies; 내과학; Complement inhibitors; ANCA associated vasculitis; Kidney diseases; Hemolytic uremic syndrome; Thrombotic microangiopathies; C5 inhibitors
• ISSN: 2211-9132; 2211-9140
• DOI: 10.23876/j.krcp.21.248

The complement pathway is an essential mechanism in innate immunity, but it is also involved in multiple pathologies. For kidney diseases, strong evidence of a dysregulation in the alternative pathway in atypical hemolytic uremic syndrome (aHUS) led to the use of eculizumab, the first anti-C5 inhibitor available in clinical practice. Intensive fundamental research resulted in the development of subsequent new drugs, such as long-acting C5 inhibitors, oral medications, or antagonists of C5aR, the receptor for C5a. New data in the domain of C5-inhibition in glomerular diseases are still limited and mainly focus on 1) the efficacy of ravulizumab, a long-acting C5 inhibitor in aHUS, and 2) the use of avacopan, a C5aR antagonist, in antineutrophil cytoplasmic antibody vasculitis. Several new studies ongoing or planned for the next few years will evaluate the efficacy of C5 inhibition in secondary thrombotic microangiopathy, C3 glomerulopathy, membranous nephropathy, or immunoglobulin A nephropathy.