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

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 pa...

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Autores principales: Menne, Jan, Delmas, Yahsou, Fakhouri, Fadi, Licht, Christoph, Lommelé, Åsa, Minetti, Enrico E., Provôt, François, Rondeau, Eric, Sheerin, Neil S., Wang, Jimmy, Weekers, Laurent E., Greenbaum, Larry A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6456946/
https://www.ncbi.nlm.nih.gov/pubmed/30971227
http://dx.doi.org/10.1186/s12882-019-1314-1
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author Menne, Jan
Delmas, Yahsou
Fakhouri, Fadi
Licht, Christoph
Lommelé, Åsa
Minetti, Enrico E.
Provôt, François
Rondeau, Eric
Sheerin, Neil S.
Wang, Jimmy
Weekers, Laurent E.
Greenbaum, Larry A.
author_facet Menne, Jan
Delmas, Yahsou
Fakhouri, Fadi
Licht, Christoph
Lommelé, Åsa
Minetti, Enrico E.
Provôt, François
Rondeau, Eric
Sheerin, Neil S.
Wang, Jimmy
Weekers, Laurent E.
Greenbaum, Larry A.
author_sort Menne, Jan
collection PubMed
description 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.
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spelling pubmed-64569462019-04-19 Outcomes in patients with atypical hemolytic uremic syndrome treated with eculizumab in a long-term observational study Menne, Jan Delmas, Yahsou Fakhouri, Fadi Licht, Christoph Lommelé, Åsa Minetti, Enrico E. Provôt, François Rondeau, Eric Sheerin, Neil S. Wang, Jimmy Weekers, Laurent E. Greenbaum, Larry A. BMC Nephrol Research Article 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. BioMed Central 2019-04-10 /pmc/articles/PMC6456946/ /pubmed/30971227 http://dx.doi.org/10.1186/s12882-019-1314-1 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Menne, Jan
Delmas, Yahsou
Fakhouri, Fadi
Licht, Christoph
Lommelé, Åsa
Minetti, Enrico E.
Provôt, François
Rondeau, Eric
Sheerin, Neil S.
Wang, Jimmy
Weekers, Laurent E.
Greenbaum, Larry A.
Outcomes in patients with atypical hemolytic uremic syndrome treated with eculizumab in a long-term observational study
title Outcomes in patients with atypical hemolytic uremic syndrome treated with eculizumab in a long-term observational study
title_full Outcomes in patients with atypical hemolytic uremic syndrome treated with eculizumab in a long-term observational study
title_fullStr Outcomes in patients with atypical hemolytic uremic syndrome treated with eculizumab in a long-term observational study
title_full_unstemmed Outcomes in patients with atypical hemolytic uremic syndrome treated with eculizumab in a long-term observational study
title_short Outcomes in patients with atypical hemolytic uremic syndrome treated with eculizumab in a long-term observational study
title_sort outcomes in patients with atypical hemolytic uremic syndrome treated with eculizumab in a long-term observational study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6456946/
https://www.ncbi.nlm.nih.gov/pubmed/30971227
http://dx.doi.org/10.1186/s12882-019-1314-1
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