Practical Considerations for Infection Prevention With the Clinical Use of Complement Inhibitors

Overactivation of the complement system plays a role in the pathophysiology of several serious kidney diseases, such as immunoglobulin A nephropathy, complement 3 glomerulopathy, atypical hemolytic uremic syndrome, and antineutrophil cytoplasmic antibody-associated vasculitis. A key focus of recent research has been developing complement inhibitors to target the underlying disease mechanisms of these diseases and thereby improve patient outcomes. Currently, five complement inhibitors are approved by the United States Food and Drug Administration as effective for the treatment of kidney diseases: eculizumab, ravulizumab, avacopan, iptacopan, and pegcetacoplan. However, some of these therapies may increase the risk of serious, potentially life-threatening infections, particularly from encapsulated organisms including Neisseria meningitidis , Streptococcus pneumoniae , and Haemophilus influenzae type b. Health care providers must recognize this risk and implement preventive measures when prescribing complement inhibitors. This review summarizes the infectious risks associated with complement inhibitors and highlights key clinical considerations for their safe and effective use in the treatment of kidney diseases. It is intended to serve as an accessible resource for providers utilizing these agents in clinical practice.