Soliris (eculizumab) is safe and effective for the prevention of recurrence in people with atypical hemolytic uremic syndrome (aHUS) who received kidney transplants, a 10-year follow-up study indicates.
aHUS is characterized by tiny clots in the blood, which can cause damage to the kidneys. Soliris (by Alexion) is an approved treatment for aHUS that is commonly used to protect the kidneys, both for native and transplanted kidneys. But there isn’t much published data on the long-term use of Soliris in people with aHUS who get kidney transplants.
In the new study, researchers reviewed clinical data for people with aHUS who underwent a kidney transplant at Johns Hopkins Hospital from 2009 to 2018. This included 19 people who received a total of 36 transplants (10 people had multiple transplants). The group was predominantly white (78%) and female (72%). The median age at the time of the most recent transplant was 37 years, and most (61%) received a transplant from a live donor.
Of the 19 individuals, 10 (56%) received preventive Soliris at the time of the most recent transplant. For three of these, Soliris was discontinued after six months when genetic analyses failed to identify a mutation that would support the use of Soliris. The remaining seven, in whom such mutations were identified, are on lifelong preventive Soliris.
Among individuals given preventive Soliris, with a median follow-up time of 39.5 months, one individual has developed kidney failure as a result of immune-mediated transplant rejection, with no evidence of aHUS recurrence. The remaining nine transplanted kidneys are still functioning.
In contrast, only three transplanted kidneys remain functioning among those not given preventive Soliris. And, whereas there was no indication of aHUS recurrence for the 10 patients given preventive Soliris, there was aHUS recurrence in 17 of 24 (70%) transplanted kidneys without preventive Soliris.
The fact that no recurrence was observed in the three individuals for whom Soliris was ceased, “shows that cessation of prophylaxis may be possible with minimal risk of recurrence, in carefully selected patients with no identified complement mutations,” the researchers wrote.
No serious infections related to Soliris were observed during the follow-up.
“In conclusion,” the researchers wrote, “this study demonstrates one of the longest follow up of kidney transplant recipients treated with eculizumab reported till date. This further consolidates the safety and efficacy of prophylactic therapy to prevent aHUS recurrence in this patient population.”
This was a fairly small study conducted at a single medical center. As such, the results may not be applicable to all people with aHUS treated at all centers; further research is needed, the researchers noted.
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