Avacopan (C5a Receptor Inhibitor — ANCA Vasculitis)

How it works

It blocks the C5a receptor on neutrophils, inhibiting C5a-driven neutrophil activation and recruitment that contribute to vascular inflammation in ANCA-associated vasculitis.

Prescribing in practice

• Hepatotoxicity has been reported, so liver function must be assessed before and monitored during treatment and the drug withheld if significant abnormalities occur.
• It is used alongside standard immunosuppressive regimens and can reduce reliance on long-term glucocorticoids.
• Serious infections may occur; avoid initiation in active serious infection and remain vigilant during therapy.

Monitoring

Monitor liver function tests before and regularly during treatment, and watch for signs of infection throughout therapy.

Counselling the patient

• Report any signs of liver problems such as jaundice, dark urine, nausea or right upper abdominal pain.
• Report fever or other signs of infection promptly.

Evidence & guidelines

Avacopan is recommended by NICE as an option for ANCA-associated vasculitis on the basis of the ADVOCATE trial, which supported its glucocorticoid-sparing role.