The long-acting C5 inhibitor, ravulizumab, is efficacious and safe in pediatric patients with atypical hemolytic uremic
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ORIGINAL ARTICLE
The long-acting C5 inhibitor, ravulizumab, is efficacious and safe in pediatric patients with atypical hemolytic uremic syndrome previously treated with eculizumab Kazuki Tanaka 1 & Brigitte Adams 2 & Alvaro Madrid Aris 3 & Naoya Fujita 1 & Masayo Ogawa 4 & Stephan Ortiz 4 & Marc Vallee 4 & Larry A. Greenbaum 5 Received: 30 June 2020 / Revised: 27 August 2020 / Accepted: 10 September 2020 # The Author(s) 2020
Abstract Background Atypical hemolytic uremic syndrome (aHUS) is a rare, complement-mediated disease associated with poor outcomes if untreated. Ravulizumab, a long-acting C5 inhibitor developed through minimal, targeted modifications to eculizumab was recently approved for the treatment of aHUS. Here, we report outcomes from a pediatric patient cohort from the ravulizumab clinical trial (NCT03131219) who were switched from chronic eculizumab to ravulizumab treatment. Methods Ten patients received a loading dose of ravulizumab on Day 1, followed by maintenance doses administered initially on Day 15, and then, every 4–8 weeks thereafter, depending on body weight. All patients completed the initial evaluation period of 26 weeks and entered the extension period. Results No patients required dialysis at any point throughout the study. The median estimated glomerular filtration rate values remained stable during the trial: 99.8 mL/min/1.73m2 at baseline, 93.5 mL/min/1.73m2 at 26 weeks, and 104 mL/min/1.73m2 at 52 weeks. At last available follow-up, all patients were in the same chronic kidney disease stage as recorded at baseline. Hematologic variables (platelets, lactate dehydrogenase, and hemoglobin) also remained stable throughout the initial evaluation period and up to the last available follow-up. All patients experienced adverse events; the most common were upper respiratory tract infection (40%) and oropharyngeal pain (30%). There were no meningococcal infections reported, no deaths occurred, and no patients discontinued during the study. Conclusions Overall, treatment with ravulizumab in pediatric patients with aHUS who were previously treated with eculizumab resulted in stable kidney and hematologic parameters, with no unexpected safety concerns when administered every 4–8 weeks. Trial registration Trial identifiers: Trial ID: ALXN1210-aHUS-312 Clinical trials.gov: NCT03131219 EudraCT number: 2016-002499-29 Keywords Atypical hemolytic uremic syndrome . Complement . Eculizumab . Hemolytic uremic syndrome . Ravulizumab . Thrombotic microangiopathy . Children Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00467-020-04774-2) contains supplementary material, which is available to authorized users. * Kazuki Tanaka [email protected] 1
2
Department of Nephrology, Aichi Children’s Health and Medical Center, 7-426, Morioka-cho, Obu City, Aichi prefecture 474-8710, Japan Department of Pediatric Nephrology, Children’s Hospital Queen Fabiola, Université libre de Bruxelles, Brussels, Belgium
3
Children’s Nephrology and Renal Transplantation
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