Eculizumab in Secondary Atypical Haemolytic Uraemic Syndrome

Nephrol Dial Transplant. 2017 Mar 1;32(3):466-474. doi: 10.1093/ndt/gfw453.

Abstract

Background: Complement dysregulation occurs in thrombotic microangiopathies (TMAs) other than primary atypical haemolytic uraemic syndrome (aHUS). A few of these patients have been reported previously to be successfully treated with eculizumab.

Methods: We identified 29 patients with so-called secondary aHUS who had received eculizumab at 11 Spanish nephrology centres. Primary outcome was TMA resolution, defined by a normalization of platelet count (>150 × 10 9 /L) and haemoglobin, disappearance of all the markers of microangiopathic haemolytic anaemia (MAHA), and improvement of renal function, with a ≥25% reduction of serum creatinine from the onset of eculizumab administration.

Results: Twenty-nine patients with secondary aHUS (15 drug-induced, 8 associated with systemic diseases, 2 with postpartum, 2 with cancer-related, 1 associated with acute humoral rejection and 1 with intestinal lymphangiectasia) were included in this study. The reason to initiate eculizumab treatment was worsening of renal function and persistence of TMA despite treatment of the TMA cause and plasmapheresis. All patients showed severe MAHA and renal function impairment (14 requiring dialysis) prior to eculizumab treatment and 11 presented severe extrarenal manifestations. A rapid resolution of the TMA was observed in 20 patients (68%), 15 of them showing a ≥50% serum creatinine reduction at the last follow-up. Comprehensive genetic and molecular studies in 22 patients identified complement pathogenic variants in only 2 patients. With these two exceptions, eculizumab was discontinued, after a median of 8 weeks of treatment, without the occurrence of aHUS relapses.

Conclusion: Short treatment with eculizumab can result in a rapid improvement of patients with secondary aHUS in whom TMA has persisted and renal function worsened despite treatment of the TMA-inducing condition.

Keywords: atypical haemolytic uraemic syndrome; complement activation; eculizumab; thrombotic microangiopathies.

MeSH terms

  • Adult
  • Antibodies, Monoclonal, Humanized / therapeutic use*
  • Atypical Hemolytic Uremic Syndrome / drug therapy*
  • Atypical Hemolytic Uremic Syndrome / etiology
  • Atypical Hemolytic Uremic Syndrome / metabolism
  • Churg-Strauss Syndrome / complications
  • Complement Inactivating Agents / therapeutic use*
  • Creatinine / metabolism
  • Female
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Kidney Function Tests
  • Lupus Erythematosus, Systemic / complications
  • Male
  • Middle Aged
  • Plasmapheresis
  • Platelet Count
  • Recurrence
  • Renal Insufficiency / etiology
  • Renal Insufficiency / metabolism
  • Scleroderma, Systemic / complications
  • Thrombotic Microangiopathies / drug therapy
  • Thrombotic Microangiopathies / metabolism

Substances

  • Antibodies, Monoclonal, Humanized
  • Complement Inactivating Agents
  • Immunosuppressive Agents
  • eculizumab
  • Creatinine