Discontinuation of Eculizumab treatment after hematological remission in patients with atypical and drug-induced hemolytic uremic syndrome

Rom J Intern Med. 2022 Mar 17;60(1):56-65. doi: 10.2478/rjim-2021-0034. Print 2022 Mar 1.

Abstract

Introduction. The aim was to evaluate the effect of therapeutic plasma exchange (TPE) and eculizumab on hematological and renal survival in atypical hemolytic uremic syndrome (aHUS), and additionally, to examine the reliability of discontinuation of eculizumab treatment.Methods. This was an observational and retrospective study of 18 patients diagnosed with aHUS.Results. The median age of the study population was 30 (22-66) years. Four of 18 patients achieved hematological remission with the TPE alone. However, one patient died after three sessions of TPE. Eculizumab was used in 13 patients and no death was observed. One year after treatment, improved kidney function was observed in 2 of 3 (66%) patients for TPE and 5 of 9 (56%) patients for Eculizumab. We discontinued eculizumab treatment in 9 patients. One of the patients who had a C3 gene mutation experienced disease relapse after Eculizumab discontinuation. None of the patients who had drug associated aHUS developed disease relapse after Eculizumab discontinuation.Conclusion. Eculizumab treatment is a life-saving therapy in aHUS. Treatment discontinuation may be considered at least six months after hematologic remission in patients who had stable renal function or no expectancy for renal survival. Moreover, drug-associated cases seem to tend not to develop disease relapse in the long term.

Keywords: atypical hemolytic uremic syndrome; discontinuation; eculizumab; prognosis; therapeutic plasma exchange.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Antibodies, Monoclonal, Humanized* / adverse effects
  • Atypical Hemolytic Uremic Syndrome* / drug therapy
  • Atypical Hemolytic Uremic Syndrome* / genetics
  • Humans
  • Middle Aged
  • Reproducibility of Results
  • Retrospective Studies
  • Young Adult

Substances

  • Antibodies, Monoclonal, Humanized
  • eculizumab