title: Effect on mother and child of eculizumab given before caesarean section in a patient with severe antiphospholipid syndrome: A case report.
abstract: BACKGROUND
  Antiphospholipid syndrome (APS) in pregnancy may trigger the life-threatening catastrophic antiphospholipid syndrome (CAPS). Complement activation is implicated in the pathogenesis, and inhibition of complement factor C5 is suggested as an additional treatment option.
  We present a pregnant patient treated with the C5-inhibitor eculizumab due to high risk of developing devastating APS-related complications. The complement inhibitory effects of the treatment were examined both in the patient and the premature infant.
  
  
  RESULTS
  Complement activity in the mother recovered considerably faster than anticipated; however, no new thrombosis or CAPS developed during the last week of pregnancy or postpartum. Blood sampling from the umbilical vein and artery, and from the infant after delivery showed low complement activity; however, only 0.3% of the eculizumab concentration detected in the mother, consistent with low placental passage of eculizumab.
  
  
  CONCLUSIONS
  The data underscore the importance of close monitoring of complement inhibition and individualizing dosage regimens in pregnant patients receiving eculizumab. We document how traditional functional complement activity tests cannot assess the effect of eculizumab in premature infants due to the very low levels of complement factors detected in this infant born in gestational week 33. Only trace amounts of eculizumab passed the placenta. In conclusion, complement C5 inhibition might be a safe candidate treatment option for APS during pregnancy and delivery, and additionally, enables prolongation of pregnancy with important weeks.
authors.affiliation: Department of Immunology, Oslo University Hospital, and K.G. Jebsen IRC, University of Oslo, Oslo, Norway. Department of Laboratory Medicine, Section of Microbiology, Immunology and Glycobiology, Lund University and Clinical Immunology and Transfusion Medicine, Region Skane, Lund, Sweden Research Laboratory, Nordland Hospital Bodø, and K.G. Jebsen TREC, University of Tromsø Department of Obstetrics Department of Haematology Department of Immunology, Section of Medical Immunology, Oslo University Hospital, Oslo Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
authors.forename: Alice
authors.initials: A
authors.lastname: Gustavsen
authors.forename: Lillemor
authors.initials: L
authors.lastname: Skattum
authors.forename: Grethe
authors.initials: G
authors.lastname: Bergseth
authors.forename: Bjorg
authors.initials: B
authors.lastname: Lorentzen
authors.forename: Yngvar
authors.initials: Y
authors.lastname: Floisand
authors.forename: Vidar
authors.initials: V
authors.lastname: Bosnes
authors.forename: Tom Eirik
authors.initials: TE
authors.lastname: Mollnes
authors.forename: Andreas
authors.initials: A
authors.lastname: Barratt-Due
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016736:Antiphospholipid Syndrome / Q000188:drug therapy*; D002585:Cesarean Section; D003182:Complement C5 / Q000037:antagonists & inhibitors*; D003165:Complement System Proteins / Q000378:metabolism; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D003182:Complement C5; D003165:Complement System Proteins; C481642:eculizumab