Glucocorticoids have, for decades, been an enduring component of treatment regimens for anti-neutrophil cytoplasm autoantibody (ANCA)-associated vasculitis. However, a growing number of studies have encouraged a move towards reduced glucocorticoid usage. Findings of the ADVOCATE trial suggest that complement blockade may pave the way for complete glucocorticoid avoidance.
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References
Walsh, M. et al. Plasma exchange and glucocorticoids in severe ANCA-associated vasculitis. N. Engl. J. Med. 382, 622–631 (2020).
Pepper, R. J. et al. A novel glucocorticoid-free maintenance regimen for anti-neutrophil cytoplasm antibody-associated vasculitis. Rheumatology. 58, 260–268 (2019).
Jayne, D. R. W. et al. Avacopan for the treatment of ANCA-associated vasculitis. N. Engl. J. Med. 384, 599–609 (2021).
Chen, M., Jayne, D. R. W. & Zhao, M. H. Complement in ANCA-associated vasculitis: mechanisms and implications for management. Nat. Rev. Nephrol. 13, 359–367 (2017).
Xiao, H. et al. C5a receptor (CD88) blockade protects against MPO-ANCA GN. J. Am. Soc. Nephrol. 25, 225–231 (2014).
Merkel, P. A. et al. Adjunctive treatment with avacopan, an oral C5a receptor inhibitor, in patients with antineutrophil cytoplasmic antibody-associated vasculitis. ACR Open Rheumatol. 2, 662–671 (2020).
Jayne, D. R. W. et al. Randomized trial of C5a receptor inhibitor avacopan in ANCA-associated vasculitis. J. Am. Soc. Nephrol. 28, 2756–2767 (2017).
Dick, J. et al. C5a receptor 1 promotes autoimmunity, neutrophil dysfunction and injury in experimental anti-myeloperoxidase glomerulonephritis. Kidney Int. 93, 615–625 (2018).
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The authors acknowledge support from the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London, UK.
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Prendecki, M., McAdoo, S.P. Targeting complement in ANCA-associated vasculitis: insights from ADVOCATE. Nat Rev Nephrol 17, 439–440 (2021). https://doi.org/10.1038/s41581-021-00417-3
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DOI: https://doi.org/10.1038/s41581-021-00417-3
