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Review
. 2024 Aug 18;16(8):e67161.
doi: 10.7759/cureus.67161. eCollection 2024 Aug.

Superiority of Avacopan and Mepolizumab to Glucocorticoid Tapering in the Treatment of Anti-neutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis: A Systematic Review

Rishma Gattu  1 , Michelle Demory Beckler  2 , Marc M Kesselman  3
Affiliations
Review

Superiority of Avacopan and Mepolizumab to Glucocorticoid Tapering in the Treatment of Anti-neutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis: A Systematic Review

Rishma Gattu et al. Cureus. .

Abstract

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) comprises a spectrum of autoimmune diseases, including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). Studies have shown that avacopan and mepolizumab are promising therapeutics for partial or complete replacement of glucocorticoids (GC), with sustained remission while completely weaning off GC. Avacopan inhibits C5aR in the complement pathway, preventing neutrophil migration, while mepolizumab targets IL-5R, reducing eosinophil activity. Additionally, complement inhibition has not only contributed to the recovery of renal function and alleviation of physical symptoms but has also enhanced patients' overall quality of life and mental well-being. This systematic review explores the pathogenesis of AAV, traditional treatments, and the potential of emerging complement and interleukin antagonist therapies such as avacopan and mepolizumab in revolutionizing AAV management.

Keywords: antineutrophil cytoplasmic antibody (anca) associated vasculitis (aav); avacopan; glucocorticoid; mepolizumab; monoclonal antibody; steroid.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA flow diagram detailing the study identification and selection for avacopan in the treatment of AAV.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses, AAV: antineutrophil cytoplasmic antibody-associated vasculitis.
Figure 2
Figure 2. PRISMA flow diagram detailing the study identification and selection for mepolizumab in the treatment of AAV.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses, AAV: antineutrophil cytoplasmic antibody-associated vasculitis.
See this image and copyright information in PMC

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