Eculizumab's Unintentional Mayhem: A Systematic Review

Abstract

Eculizumab, first-line therapy for paroxysmal nocturnal hemoglobinuria (PNH) and atypical hemolytic uremic syndrome (aHUS), has infectious side effects in addition to its therapeutic benefits. This study aims to discuss the mechanism of development of infections, prevention, and timely treatment to prevent complications such as septic shock and mortality. The study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist and reporting guidelines for systematic review. Inclusion and exclusion criteria were determined. A total of 10 research papers were extracted after exploring Pubmed and Google Scholar from 2001 to 2021. The New Castle Ottawa Questionnaire for nonrandomized clinical trials and the National Institutes of Health (NIH) quality assessment tool for case reports and case series were used to assess the risk of bias. The studies included in this systematic review describe infections with Neisseria meningitidis, Neisseria gonorrhoeae, unusual Neisseria species, Moraxella lacunata, and Pseudomonas aeruginosa. The main goal of this review is to impress upon the seriousness of the infectious complications associated with eculizumab. Health care providers should maintain a high index of suspicion for early identification and treatment.

Thrombosis and meningococcal infection rates in pegcetacoplan-treated patients with paroxysmal nocturnal hemoglobinuria in the clinical trial and postmarketing settings

“…By comparison, no meningococcal infections were reported in the 2-year extension study of ravulizumab (662 patient-years) [ 8 ], but 1 fatal case and 1 life-threatening case of meningococcal sepsis were reported in patients receiving ravulizumab for 2.2 years and 1 year, respectively [ 24 , 25 ]. Several cases of encapsulated bacterial infections, including meningococcal infections, have also been reported in patients receiving eculizumab [ 26 , 27 ]. In a recent international PNH registry study of patients with PNH who received meningococcal vaccination before being treated with eculizumab and were receiving prophylactic antibiotics during C5 inhibitor treatment, the meningococcal infection rate was 0.1 per 100 (95% CI, 0.0-0.4) patient-years [ 28 ].…”

The Latest Ideas of Medical and Biological Developments and Improvement of Psychological Sciences by Scientists

“…Eculizumab, initially approved for paroxysmal nocturnal hemoglobinuria (PNH), has also shown efficacy in treating atypical hemolytic uremic syndrome (aHUS) [256].…”