Is There a Place for Complement Inhibition with Monoclonal Anti-C5a Antibody Vilobelimab in the Treatment of Patients with ANCA-associated Vasculitis?

Recent studies have implicated the complement system in pathogenesis of antineutrophil cytoplasmic antibody-associated vasculitis (AAV), prompting development novel therapeutic agents to target accordingly. The pivotal role component C5a, particular, has been subject a number phase II and III clinical trials. Indeed, US Food Drug Administration already approved avacopan, an oral C5a receptor inhibitor, as adjunct for treatment active severe AAV, based on its favourable safety profile non-inferiority glucocorticoids (GCs) (at Week 26). monoclonal anti-C5a antibody vilobelimab also studied trial patients with AAV (IXchange; ClinicalTrials.gov Identifier: NCT03895801). results appear promising; addition decreased GC toxicity index, smaller treatment-emergent adverse events observed vilobelimab-treated patients. However, study was not powered statistically compare efficacy standard treatment. This editorial summarizes findings outlines potential future directions.