Outcomes in patients with atypical hemolytic uremic syndrome treated with eculizumab in a long-term observational study

Abstract

Background There are limited long-term outcome data in eculizumab-treated patients with atypical hemolytic uremic syndrome (aHUS). We report final results from the largest prospective, observational, multicenter study of patients with aHUS treated with eculizumab. Methods Patients with aHUS who participated in any of five parent eculizumab trials and received at least one eculizumab infusion were eligible for enrollment in a long-term follow-up study. Rates of thrombotic microangiopathy (TMA) manifestations off versus on eculizumab were evaluated. Additional endpoints included change from baseline estimated glomerular filtration rate (eGFR), long-term renal outcomes, and serious targeted treatment-emergent adverse events. Results Among 93 patients (0–80 years of age), 51 (55%) remained on eculizumab and 42 (45%) discontinued; for those who discontinued, 21 (50%) reinitiated therapy. Patients who reinitiated eculizumab had similar baseline clinical characteristics to patients who remained on eculizumab, with higher likelihood of genetic/autoimmune complement abnormalities, more prior TMAs, and longer disease course versus those who did not reinitiate. Mean eGFR improved rapidly and remained stable for up to 6 years on eculizumab. In patients who discontinued, there was a trend toward decreasing renal function over time from discontinuation. Additionally, off-treatment TMA manifestation rates were higher in those aged < 18 years at diagnosis, with identified genetic/autoimmune complement abnormalities, or history of multiple TMAs prior to eculizumab initiation. The safety profile was consistent with previous studies. Three definite and one possible meningococcal infections related to eculizumab were reported and resolved with treatment. Three deaths unrelated to eculizumab were reported. Conclusions The current study confirms the efficacy and safety of eculizumab in aHUS, particularly with regard to long-term renal function and TMA events. Pediatric age at disease onset and presence of genetic or autoimmune complement abnormalities are risk factors for TMA events off treatment. Overall, patients who discontinue eculizumab may be at risk for additional TMA manifestations and renal function decreases. Discontinuation of eculizumab, with careful monitoring, is an option in select patients with consideration of patient preference, organ function normalization, and risk factors for relapse, including mutational analysis, age of onset, and history of multiple TMA episodes. Trial registration ClinicalTrials.gov NCT01522170 , January 31, 2012. Electronic supplementary material The online version of this article (10.1186/s12882-019-1314-1) contains supplementary material, which is available to authorized users.

The long-acting C5 inhibitor, ravulizumab, is efficacious and safe in pediatric patients with atypical hemolytic uremic syndrome previously treated with eculizumab

“…The complement protein C5 inhibitor eculizumab (Soliris®, Alexion Pharmaceuticals, Inc., Boston, MA, United States) has been shown to be efficacious and safe in treating aHUS in adults and children over the last decade, both in clinical trials and real-world settings [6][7][8][9][10][11][12][13]. However, despite its proven effectiveness, intravenous (IV) eculizumab infusions are required once every 2 weeks, which may be burdensome for patients and caregivers.…”

Rapid Resolution of Atypical Hemolytic Uremic Syndrome by Eculizumab Treatment

“…But plasma therapy was not effective; historically, aHUS had a poor prognosis with significant morbidity and mortality, with up to 50% of pa www.chikd.org tients progressing to endstage renal disease (ESRD), and 10 to 15% mortality rate during the acute phase. Treatment with eculizumab was proven to be effective in aHUS, sub stantially improving patient survival and preventing prog ression to ESRD and disease recurrence 6,9,10) . Eculizumab in aHUS led to hematological normalization and reduced renal injury with significantly improved kidney function.…”

Consensus regarding diagnosis and management of atypical hemolytic uremic syndrome

“…The use of eculizumab as a preemptive strategy in KT candidates with known aHUS is ongoing. Several studies have reported the clinical outcomes of KT recipients with ec-ulizumab prophylaxis [89][90][91]. The results showed that eculizumab prophylaxis at the time of KT markedly reduced the incidence of recurrent TMA events, compared to data from the era before eculizumab [28,86].…”