Safety and effectiveness of eculizumab for adult patients with atypical hemolytic-uremic syndrome in Japan: interim analysis of post-marketing surveillance

Abstract

Background: Eculizumab has been available for the treatment of atypical hemolytic-uremic syndrome (aHUS) in Japan since 2013. To assess safety and effectiveness of eculizumab in adult aHUS patients in the real-life setting, we performed interim analysis of a post-marketing surveillance mandated by Japanese regulations.

Methods: This study enrolled any patient who was diagnosed with TMA excluding Shiga toxin-producing Escherichia coli-HUS or thrombotic thrombocytopenic purpura based on Japanese clinical guide published in 2013 as inclusion criteria and treated with eculizumab. Although the term aHUS was redefined to denote only complement-mediated HUS in the guide revised in 2016, the patients with TMA caused by other causes (secondary TMA) were included. Patient outcomes and safety were evaluated at 6 months, 12 months, and annually thereafter.

Results: Thirty-three patients with aHUS and 27 patients with secondary TMA were enrolled. Median treatment duration of aHUS was 24weeks. Complement genes variants were detected in 11 of 18 patients with aHUS (61.1%). Among the 29 aHUS patients with available baseline data, platelet count (PLT), lactic dehydrogenase and serum creatinine (SCr) improved within 1-month after eculizumab initiation. TMA event-free status, complete TMA response, PLT normalization, and SCr decrease were achieved in 67.9% (19/28), 27.8% (5/18), 56.5% (13/23), and 57.1% (16/28) of patients, respectively. Thirty-three and 11 adverse reactions were observed in patients with aHUS (13/33 patients) and secondary TMA (6/27 patients), respectively.

Conclusions: This interim analysis confirmed the acceptable safety profile and effectiveness of eculizumab for Japanese adult aHUS patients in real-world settings.

Keywords: Atypical hemolytic–uremic syndrome; C5 inhibitor; Complement; Eculizumab; Post-marketing surveillance.

Fig. 1

The level of platelet count, LDH and Serum creatinine during eculizumab treatment of aHUS patients. a PLT was significantly improved from 1week of eculizumab initiation in aHUS (complement-mediated HUS) patients. Changes from baseline were compared using the paired t test. *P < 0.05, **P < 0.01, ***P < 0.001 vs eculizumab initiation. b LDH was significantly improved from 1week of eculizumab initiation in aHUS (complement-mediated HUS) patients. Changes from baseline were compared using the paired t test. *P < 0.05, **P < 0.01, ***P < 0.001 vs eculizumab initiation. c SCr was significantly improved from 4 weeks of eculizumab initiation in aHUS (complement-mediated HUS) patients. Changes from baseline were compared using the paired t test. *P < 0.05, vs eculizumab initiation