Case Report: Variable Pharmacokinetic Profile of Eculizumab in an aHUS Patient
BackgroundWith the introduction of eculizumab, a C5-inhibitor, morbidity and mortality improved significantly for patients with atypical hemolytic uremic syndrome (aHUS). In view of the high costs, actual needs of the drug, and increasing evidence in literature, aHUS patients can be treated accordin...
Main Authors: | , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Frontiers Media S.A.
2021-01-01
|
Series: | Frontiers in Immunology |
Subjects: | |
Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2020.612706/full |
id |
doaj-23408f3b87bb415c8e88c8a8caae52f7 |
---|---|
record_format |
Article |
spelling |
doaj-23408f3b87bb415c8e88c8a8caae52f72021-01-15T04:16:56ZengFrontiers Media S.A.Frontiers in Immunology1664-32242021-01-011110.3389/fimmu.2020.612706612706Case Report: Variable Pharmacokinetic Profile of Eculizumab in an aHUS PatientRomy N. Bouwmeester0Mendy Ter Avest1Kioa L. Wijnsma2Caroline Duineveld3Rob ter Heine4Elena B. Volokhina5Lambertus P. W. J. Van Den Heuvel6Jack F. M. Wetzels7Nicole C. A. J. van de Kar8Department of Pediatric Nephrology, Radboud Institute for Molecular Life Sciences, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, NetherlandsDepartment of Pharmacy, Radboud University Medical Center, Nijmegen, NetherlandsDepartment of Pediatric Nephrology, Radboud Institute for Molecular Life Sciences, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, NetherlandsDepartment of Nephrology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, NetherlandsDepartment of Pharmacy, Radboud University Medical Center, Nijmegen, NetherlandsDepartment of Pediatric Nephrology, Radboud Institute for Molecular Life Sciences, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, NetherlandsDepartment of Pediatric Nephrology, Radboud Institute for Molecular Life Sciences, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, NetherlandsDepartment of Nephrology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, NetherlandsDepartment of Pediatric Nephrology, Radboud Institute for Molecular Life Sciences, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, NetherlandsBackgroundWith the introduction of eculizumab, a C5-inhibitor, morbidity and mortality improved significantly for patients with atypical hemolytic uremic syndrome (aHUS). In view of the high costs, actual needs of the drug, and increasing evidence in literature, aHUS patients can be treated according to a restrictive eculizumab regimen. We retrospectively analyzed the pharmacokinetic and dynamic parameters of eculizumab in one patient in time, emphasizing various factors which could be taken into account during tapering of treatment.Case PresentationA nowadays 18-year-old male with a severe, frequently relapsing form of atypical HUS due to a hybrid CFH/CFHR1 gene in combination with the homozygous factor H haplotype, required chronic plasma therapy (PT), including periods with plasma infusion, from the age of onset at 5 months until initiation of eculizumab at the age of 11 years. A mild but stable chronic kidney disease (CKD) and 9 years of disease remission enabled prolongation of eculizumab interval. At the age of 15 years, a sudden yet multifactorial progression of chronic kidney disease (CKD) was observed, without any signs of disease recurrence. However, an acquired glomerulocystic disease, a reduced left kidney function, and abnormal abdominal venous system of unknown etiology were found. In addition, after an aHUS relapse, an unexpected increase in intra-patient variability of eculizumab concentrations was seen. Retrospective pharmacokinetic analysis revealed a change in eculizumab clearance, associated with a simultaneous increase in proteinuria.ConclusionHigh intra-patient variability of eculizumab pharmacokinetics were observed over time, emphasizing the necessity for adequate and continuous therapeutic drug monitoring in aHUS patients. Eculizumab serum trough levels together with complement activation markers (CH50) should be frequently assessed, especially during tapering of drug therapy and/or changing clinical conditions in the patient. In addition, an increase in proteinuria could result in urinary eculizumab loss, indicating that urinary monitoring of eculizumab may be important in aHUS patients with an unexplained decline in serum concentrations.https://www.frontiersin.org/articles/10.3389/fimmu.2020.612706/fullatypical hemolytic uremic syndromeaHUSeculizumabtherapeutic drug monitoringpharmacokineticproteinuria |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Romy N. Bouwmeester Mendy Ter Avest Kioa L. Wijnsma Caroline Duineveld Rob ter Heine Elena B. Volokhina Lambertus P. W. J. Van Den Heuvel Jack F. M. Wetzels Nicole C. A. J. van de Kar |
spellingShingle |
Romy N. Bouwmeester Mendy Ter Avest Kioa L. Wijnsma Caroline Duineveld Rob ter Heine Elena B. Volokhina Lambertus P. W. J. Van Den Heuvel Jack F. M. Wetzels Nicole C. A. J. van de Kar Case Report: Variable Pharmacokinetic Profile of Eculizumab in an aHUS Patient Frontiers in Immunology atypical hemolytic uremic syndrome aHUS eculizumab therapeutic drug monitoring pharmacokinetic proteinuria |
author_facet |
Romy N. Bouwmeester Mendy Ter Avest Kioa L. Wijnsma Caroline Duineveld Rob ter Heine Elena B. Volokhina Lambertus P. W. J. Van Den Heuvel Jack F. M. Wetzels Nicole C. A. J. van de Kar |
author_sort |
Romy N. Bouwmeester |
title |
Case Report: Variable Pharmacokinetic Profile of Eculizumab in an aHUS Patient |
title_short |
Case Report: Variable Pharmacokinetic Profile of Eculizumab in an aHUS Patient |
title_full |
Case Report: Variable Pharmacokinetic Profile of Eculizumab in an aHUS Patient |
title_fullStr |
Case Report: Variable Pharmacokinetic Profile of Eculizumab in an aHUS Patient |
title_full_unstemmed |
Case Report: Variable Pharmacokinetic Profile of Eculizumab in an aHUS Patient |
title_sort |
case report: variable pharmacokinetic profile of eculizumab in an ahus patient |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Immunology |
issn |
1664-3224 |
publishDate |
2021-01-01 |
description |
BackgroundWith the introduction of eculizumab, a C5-inhibitor, morbidity and mortality improved significantly for patients with atypical hemolytic uremic syndrome (aHUS). In view of the high costs, actual needs of the drug, and increasing evidence in literature, aHUS patients can be treated according to a restrictive eculizumab regimen. We retrospectively analyzed the pharmacokinetic and dynamic parameters of eculizumab in one patient in time, emphasizing various factors which could be taken into account during tapering of treatment.Case PresentationA nowadays 18-year-old male with a severe, frequently relapsing form of atypical HUS due to a hybrid CFH/CFHR1 gene in combination with the homozygous factor H haplotype, required chronic plasma therapy (PT), including periods with plasma infusion, from the age of onset at 5 months until initiation of eculizumab at the age of 11 years. A mild but stable chronic kidney disease (CKD) and 9 years of disease remission enabled prolongation of eculizumab interval. At the age of 15 years, a sudden yet multifactorial progression of chronic kidney disease (CKD) was observed, without any signs of disease recurrence. However, an acquired glomerulocystic disease, a reduced left kidney function, and abnormal abdominal venous system of unknown etiology were found. In addition, after an aHUS relapse, an unexpected increase in intra-patient variability of eculizumab concentrations was seen. Retrospective pharmacokinetic analysis revealed a change in eculizumab clearance, associated with a simultaneous increase in proteinuria.ConclusionHigh intra-patient variability of eculizumab pharmacokinetics were observed over time, emphasizing the necessity for adequate and continuous therapeutic drug monitoring in aHUS patients. Eculizumab serum trough levels together with complement activation markers (CH50) should be frequently assessed, especially during tapering of drug therapy and/or changing clinical conditions in the patient. In addition, an increase in proteinuria could result in urinary eculizumab loss, indicating that urinary monitoring of eculizumab may be important in aHUS patients with an unexplained decline in serum concentrations. |
topic |
atypical hemolytic uremic syndrome aHUS eculizumab therapeutic drug monitoring pharmacokinetic proteinuria |
url |
https://www.frontiersin.org/articles/10.3389/fimmu.2020.612706/full |
work_keys_str_mv |
AT romynbouwmeester casereportvariablepharmacokineticprofileofeculizumabinanahuspatient AT mendyteravest casereportvariablepharmacokineticprofileofeculizumabinanahuspatient AT kioalwijnsma casereportvariablepharmacokineticprofileofeculizumabinanahuspatient AT carolineduineveld casereportvariablepharmacokineticprofileofeculizumabinanahuspatient AT robterheine casereportvariablepharmacokineticprofileofeculizumabinanahuspatient AT elenabvolokhina casereportvariablepharmacokineticprofileofeculizumabinanahuspatient AT lambertuspwjvandenheuvel casereportvariablepharmacokineticprofileofeculizumabinanahuspatient AT jackfmwetzels casereportvariablepharmacokineticprofileofeculizumabinanahuspatient AT nicolecajvandekar casereportvariablepharmacokineticprofileofeculizumabinanahuspatient |
_version_ |
1724337596615622656 |