Table 2.
Main complement inhibitors undergoing development in kidney diseases
| Target in the complement cascade | Mechanism of action | Drug | Pharmaceutical company | Type of inhibitor | Mode of administration | Phases of drug development | Potential indications in kidney diseases |
|---|---|---|---|---|---|---|---|
| C5 | Inhibition of the release of C5a and C5b, and ultimately of the formation of C5b9 | Eculizumab | Alexion Pharma/AstraZeneca | mAb | i.v. | Commercialized | aHUS |
| Ravulizumab | Alexion Pharma/AstraZeneca | mAb | i.v. | Commercialized, phase III | aHUS | ||
| Crovalimab | Roche | mAb | s.c. | Phases II–III | aHUS | ||
| C3 | Inhibition of the binding of C3 to the C3bBb and thus of the cleavage of C3 | Pegcetacoplan | Apellis Pharma/SOBI | Pegylated peptide | s.c. | Phase III | C3G, IgAN, MN |
| Factor B | Inhibition of the serine protease FB and thus of the cleavage of C3 and C5 | Iptacopan | Novartis | Small molecule | Oral | Phases II–III | aHUS, C3G, MN, IgAN |
| Factor D | Inhibition of the cleavage of FB | Danicopan | A Alexion Pharma/AstraZeneca | Small molecule | Oral | Phases II–III | C3G |
| MASP2 | Inhibition of the serine protease MASP2 | Narsoplimab | Omeros | mAb | i.v. | Phase II | IgAN |
| C5a receptor | Inhibition of the binding of C5a to its receptor | Avacopan | Chemocentrix | Small molecule | Oral | Phase III | ANCA-associated vasculitis aHUS |
aHUS, atypical hemolytic uremic syndrome; ANCA, anti-neutrophil cytoplasmic autoantibody; C3G, C3 glomerulopathy; IgAN, IgA nephropathy; mAb, monoclonal antibody; MN, membranous nephropathy; s.c., subcutaneously.