Table 3.

Eculizumab: practical considerations

Eculizumab: Practical Considerations
Before administration
 Meningococcal vaccination mandatory
 Tetravalent ACWY conjugated vaccine + multicomponent serogroup B vaccine
Prophylaxis
 Long-term antibiotic prophylaxis recommended
Administration
 Intravenous infusion
 Maintenance therapy is administered every 14 d
Monitoring
 CH50 and AH50 <10%
 Eculizumab trough level 100 µg/ml
 Hematologic indicators of TMA
Patient education
 Vigilance regarding meningococcal infection
Counseling family members
 Genetic screening
When to stop?
 Continue during intercurrent illness, unless infection with encapsulated organism, due to high risk of TMA relapse in this context
Withdrawal
 Systematic investigation in clinical trials is being undertaken
 May be appropriate in some patientsa, with monitoring: liaise with specialist center
  • This guidance is based on our practice in the United Kingdom, and the 2015 Kidney Disease: Improving Global Outcomes Controversies Conference consensus recommendations (6). Eculizumab (Soliris; Alexion Pharmaceuticals) is a recombinant humanized mAb that functionally blocks C5, and is approved by the US Food and Drug Administration and the European Medicines Agency for use in atypical hemolytic uremic syndrome. ACWY, meningococcal serotypes; CH50, total complement hemolytic activity; AH50, alternative pathway hemolytic activity; TMA, thrombotic microangiopathy; aHUS, atypical hemolytic uremic syndrome.

  • a For example, if there is no renal recovery after 6 months of treatment.