Eculizumab in pregnancy: a narrative overview

Sarno, Laura; Tufano, Antonella; Maruotti, Giuseppe Maria; Martinelli, Pasquale; Balletta, M; Russo, Domenico

doi:10.1007/s40620-018-0517-z

Cited by 53 publications

(51 citation statements)

References 24 publications

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“…Eculizumab, a monoclonal antibody inhibitor of C5, reduces the generation of complement components C5a and C5b-9 and their downstream effects. Eculizumab appears to be safe in pregnancy as demonstrated by its use in paroxysmal nocturnal hemoglobinuria18 19 and atypical hemolytic uremic syndrome (aHUS) 19–21…”

Section: Discussionmentioning

confidence: 99%

Eculizumab, a novel potential treatment for acute kidney injury associated with preeclampsia/HELLP syndrome

et al. 2019

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The kidney is one of the major organs affected in preeclampsia. There is evidence suggesting a role for excessive complement activation in the pathogenesis of preeclampsia. We describe a case of preeclampsia with severe features, including HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) and acute kidney injury (AKI) that developed following caesarian section. The patient required renal replacement therapy. A trial of daily plasma exchange was not effective. The patient received a single dose of eculizumab, a humanised monoclonal IgG antibody that binds to complement protein C5. One week post administration of eculizumab, there was significant improvement in haematologic, hepatic and renal function. Blood pressure had normalised and renal replacement therapy was discontinued. The use of eculizumab may have contributed to recovery of kidney function further supporting the role of complement activation in the pathogenesis of preeclampsia and associated AKI.

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Section: Discussionmentioning

confidence: 99%

Eculizumab, a novel potential treatment for acute kidney injury associated with preeclampsia/HELLP syndrome

et al. 2019

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“…The advent of eculizumab has the potential to dramatically improve the outcome of this highly morbid disease 9. Eculizumab is a humanised monoclonal antibody that blocks the cleavage of the terminal complement protein C5 preventing formation of MAC10 and has been used to treat P-aHUS with improvement in haematological and renal parameters in a patient who carried heterozygous mutations in the CFH and CFI genes 11.…”

Section: Discussionmentioning

confidence: 99%

Recurrent case of pregnancy-induced atypical haemolytic uremic syndrome (P-aHUS)

Kumar¹,

King

Jim

et al. 2019

BMJ Case Rep

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Pregnancy-induced atypical haemolytic uremic syndrome (P-aHUS) is a rare condition characterised by microangiopathic haemolytic anaemia, thrombocytopenia and renal failure. It accounts for approximately 7% of total HUS cases. Here, we present a case of recurrent P-aHUS in a 25-year-old Hispanic woman. Pregnancy was the clear trigger in both instances, and the disease manifested in first week of the postpartum period. Because of her significant obstetric history, a multidisciplinary approach was adopted to monitor her second pregnancy antepartum and post partum. As the patient developed recurrence of P-aHUS 4 days after her delivery, she was immediately administered eculizumab within few hours of disease manifestation. The patient normalised her haematological parameters within 1 week but sustained dialysis-requiring renal failure for a total of 6 weeks. This case highlights the advances as well as the ongoing uncertainties, especially with respect to the use of eculizumab, in this rare but morbid disease.

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“…48 There are multiple cases of normal complement levels in exposed newborns. 47,49,50 It has also been suggested that low complement levels may be related to prematurity associated with the underlying disease. 51,52 Further data are needed to conclusively determine whether this drug is safe to be used during pregnancy.…”

Section: Hyperhemolysis Prophylaxismentioning

confidence: 99%

Peripartum hyperhemolysis prophylaxis and management in sickle cell disease: A case report and narrative review

et al. 2020

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Background: Sickle cell disease (SCD) is associated with hematologic complications including delayed hemolytic transfusion reactions (DHTRs) and pregnancy-related morbidity and mortality. Hyperhemolysis syndrome (HS) is the most severe form of DHTR in patients with SCD, in which both transfused and native red blood cells are destroyed. Further transfusions are avoided after a history of HS. Immunosuppressive agents can be used as prophylaxis against life-threatening hemolysis when transfusion is necessary. There is a paucity of evidence for the use of HS prophylaxis before transfusions, the continuation of hydroxyurea (HU) in lieu of chronic transfusion, and the use of erythropoiesisstimulating agents (ESA) in pregnant SCD patients. Case Report: We present a case of a pregnant patient with SCD and a previous history of HS. HS prophylaxis was given before transfusion with corticosteroids, intravenous immunoglobulin, and rituximab. In addition, HU was continued during pregnancy to control SCD, along with the use of concomitant ESA to maintain adequate hemoglobin levels and avoid transfusion. We describe a multidisciplinary approach to pregnancy and delivery management including tailored anesthetic and obstetric planning. Conclusion: This is the first published case of HS prophylaxis in a pregnant SCD patient, with good maternal and fetal outcomes after transfusion. HU and ESAs were able to control SCD and mitigate anemia in lieu of prophylactic transfusions during pregnancy. Further prospective studies are necessary to elucidate the ideal management of pregnant SCD patients with a history of HS or other contraindications to chronic transfusion.

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Eculizumab in pregnancy: a narrative overview

Cited by 53 publications

References 24 publications

Eculizumab, a novel potential treatment for acute kidney injury associated with preeclampsia/HELLP syndrome

Eculizumab, a novel potential treatment for acute kidney injury associated with preeclampsia/HELLP syndrome

Recurrent case of pregnancy-induced atypical haemolytic uremic syndrome (P-aHUS)

Peripartum hyperhemolysis prophylaxis and management in sickle cell disease: A case report and narrative review

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