title: A Case Report and Literature Review of Eculizumab Withdrawal in Atypical Hemolytic-Uremic Syndrome.
abstract: BACKGROUND Recent advances in the treatment of atypical hemolytic-uremic syndrome (aHUS) have resulted to better long-term survival rates for patients with this life-threatening disease. However, many questions remain such as whether or not long-term treatment is necessary in some patients and what are the risks of prolonged therapy. CASE REPORT Here, we discuss the case of a 37-year-old woman with CFH and CD46 genetic abnormalities who developed aHUS with severe renal failure. She was successfully treated with three doses of rituximab and a three month treatment with eculizumab. After eculizumab withdrawal, symptoms of thrombotic micro-angiopathy (TMA) recurred, therefore eculizumab treatment was restarted. The patient exhibited normal renal function and no symptoms of aHUS at one-year follow-up with further eculizumab treatment. CONCLUSIONS This case highlights the clinical challenges of the diagnosis and management of patient with aHUS with complement-mediated TMA involvement. Attention was paid to the consequences of the treatment withdrawal. Exact information regarding genetic abnormalities and renal function associated with aHUS, as well as estimations of the relapse risk and monitoring of complement tests may provide insights into the efficacy of aHUS treatment, which will enable the prediction of therapeutic responses and testing of new treatment options. Improvements in our understanding of aHUS and its causes may facilitate the identification of patients in whom anti-complement therapies can be withdrawn without risk.
authors.affiliation: Nephrology Unit, HM Hospitals, Madrid, Spain.
authors.forename: Borja
authors.initials: B
authors.lastname: Quiroga
authors.affiliation: Nephrology Unit, HM Hospitales, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: de Lorenzo
authors.affiliation: Nephrology Unit, HM Hospitales, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Vega
authors.affiliation: Nephrology Unit, HM Hospitales, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: de Alvaro
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects*; D065766:Atypical Hemolytic Uremic Syndrome / Q000188:drug therapy*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage / Q000009:adverse effects*; D013375:Substance Withdrawal Syndrome; D057049:Thrombotic Microangiopathies / Q000139:chemically induced*; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007155:Immunologic Factors; C481642:eculizumab