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Levy AR, Chen P, Johnston K, Wang Y, Popoff E, Tomazos I. Quantifying the economic effects of ravulizumab versus eculizumab treatment in patients with atypical hemolytic uremic syndrome. J Med Econ 2022; 25:249-259. [PMID: 35020547 DOI: 10.1080/13696998.2022.2027706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS This study compared the aggregate duration of treatment administration of approved eculizumab and ravulizumab treatment regimens and resultant productivity implications for patients with atypical hemolytic uremic syndrome (aHUS) and their caregivers. METHODS The aggregate duration of treatment administration (which includes waiting time for medication preparation and time for infusion, recovery, and travel to and from the clinic) was determined for a hypothetical population of patients with aHUS treated with eculizumab (10 mg/mL) or ravulizumab (10 or 100 mg/mL), in the clinic or at home, for 1 year, in Germany, Italy, the UK, and the US. The data for US patients treated in the clinic was used to extend a previously published cost-minimization model (CMM) to estimate the annual lost productivity associated with treatment administration and to compare the overall annual treatment costs for hypothetical adult and pediatric patients in the US. RESULTS The aggregate duration of treatment administration associated with ravulizumab 10 mg/mL and 100 mg/mL was reduced by 44-52% and 69-74%, respectively, compared with eculizumab 10 mg/mL, across all four countries. Using the CMM, the adult and pediatric US patient lost productivity costs due to treatment were reduced by 56-60% and 73-76% with ravulizumab 10 mg/mL and 100 mg/mL, respectively, compared with eculizumab 10 mg/mL, and overall discounted annual treatment costs (direct and lost productivity costs owing to treatment) were reduced for ravulizumab (10 mg/mL and 100 mg/mL) vs eculizumab 10 mg/mL for adult and pediatric patients. LIMITATIONS This study was based on hypothetical patients, and assumptions were made regarding caregiver involvement, patient characteristics, and treatment patterns. CONCLUSIONS Compared with eculizumab, ravulizumab reduces the lost productivity costs associated with treatment. This reduction in costs is greater with the ravulizumab 100 mg/mL formulation, compared with ravulizumab 10 mg/mL, owing to shorter infusion times with this more concentrated formulation.
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Affiliation(s)
- Adrian R Levy
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Peter Chen
- Alexion, AstraZeneca Rare Disease, Boston, MA, USA
| | - Karissa Johnston
- Broadstreet Health Economics and Outcomes Research, Vancouver, BC, Canada
| | - Yan Wang
- Alexion, AstraZeneca Rare Disease, Boston, MA, USA
| | - Evan Popoff
- Broadstreet Health Economics and Outcomes Research, Vancouver, BC, Canada
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Bicoll PS, Goyal A, Blatt NB, Freij BJ. Eculizumab-Associated Moraxella lacunata Bacteremia and Systemic Inflammatory Response Syndrome in a Toddler with Atypical Hemolytic Uremic Syndrome. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2021; 15:1179556521992367. [PMID: 33613039 PMCID: PMC7876576 DOI: 10.1177/1179556521992367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/04/2021] [Indexed: 11/16/2022]
Abstract
Moraxella lacunata, a low-virulence Gram-negative coccobacillus, is classically associated with conjunctivitis and upper respiratory tract infections; systemic infections such as sepsis have rarely been reported, especially in children. We describe a 28-month-old girl with atypical hemolytic uremic syndrome and stage II chronic kidney disease on long-term eculizumab therapy who presented with systemic inflammatory response syndrome and was found to have Moraxella lacunata bloodstream infection. Eculizumab, a humanized monoclonal anti-C5 antibody, has been associated with susceptibility to infections with encapsulated bacteria, especially Neisseria meningitidis. This is the first report of an invasive bacterial infection with Moraxella lacunata in a pediatric eculizumab recipient.
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Affiliation(s)
- Paige S Bicoll
- Beaumont Children's Hospital, Royal Oak, Michigan and Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Ashima Goyal
- Beaumont Children's Hospital, Royal Oak, Michigan and Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Neal B Blatt
- Beaumont Children's Hospital, Royal Oak, Michigan and Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Bishara J Freij
- Beaumont Children's Hospital, Royal Oak, Michigan and Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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Yüksel S, Işık Gönül İ, Canpolat N, Gökçe İ, Özlü SG, Özçakar ZB, Ozaltin F, Söylemezoğlu O. Renal Biopsy Prognostic Findings in Children With Atypical Hemolytic Uremic Syndrome. Pediatr Dev Pathol 2020; 23:362-371. [PMID: 32406813 DOI: 10.1177/1093526620925947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this study was to investigate the histopathological findings in kidney biopsies in children with atypical hemolytic uremic syndrome (aHUS) and to determine whether specific pathological findings in aHUS have a prognostic value. METHODS Renal biopsy specimens of 29 patients who were recorded in the national Turkish aHUS registry database were available for review. Histopathological findings were compared with the clinical and laboratory features at the presentation and the final outcome. RESULTS The mean age at presentation and follow-up period was 4.9 ± 3.9 and 3.9 ± 3.0 years, respectively. The median time interval from the first symptom to biopsy was 10 days. Vascular thrombosis and interstitial fibrosis were significantly related to chronic kidney disease (CKD) requiring dialysis or kidney transplantation during follow-up (5.6-fold, for both). Glomerular necrosis, cortical necrosis, and glomerular sclerosis were markedly associated with CKD without dialysis (6.2-fold, 13.3-fold, and 8.8-fold, respectively). However, presence of endothelial swelling, subendothelial widening, and fragmented erythrocytes was found to be correlated with a favorable final outcome. CONCLUSIONS Presence of vascular thrombosis, cortical necrosis, and glomerular sclerosis in histopathological evaluation correlated with developing CKD. Chronic changes in the interstitial compartment were also related to poor prognosis, a finding that has been shown for the first time in pediatric aHUS cases.
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Affiliation(s)
- Selçuk Yüksel
- Department of Pediatric Nephrology, Pamukkale University School of Medicine, Denizli, Turkey
| | - İpek Işık Gönül
- Department of Pathology, Gazi University School of Medicine, Ankara, Turkey
| | - Nur Canpolat
- Department of Pediatric Nephrology, Istanbul University Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - İbrahim Gökçe
- Department of Pediatric Nephrology, Marmara University School of Medicine, Istanbul, Turkey
| | - Sare Gülfem Özlü
- Department of Pediatric Nephrology, Ministry of Health Sami Ulus Children Hospital, Ankara, Turkey
| | - Zeynep Birsin Özçakar
- Department of Pediatric Nephrology, Ankara University School of Medicine, Ankara, Turkey
| | - Fatih Ozaltin
- Department of Pediatric Nephrology and Nephrogenetics Laboratory, Hacettepe University School of Medicine, Ankara, Turkey
| | - Oğuz Söylemezoğlu
- Department of Pediatric Nephrology, Gazi University School of Medicine, Ankara, Turkey
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Girişgen İ, Yüksel S. Diyare ilişkili hemolitik üremik sendrom hastalarımız; bölgesel sıklık artışı ve klinik sonuçları. PAMUKKALE MEDICAL JOURNAL 2019. [DOI: 10.31362/patd.601262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
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Polat M, Yüksel S, Şahin NÜ. Fatal meningococcemia due to Neisseria meningitidis serogroup Y in a vaccinated child receiving eculizumab. Hum Vaccin Immunother 2018; 14:2802. [PMID: 29883245 DOI: 10.1080/21645515.2018.1486157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Meltem Polat
- a Pamukkale University School of Medicine , Department of Pediatric Infectious Diseases , Denizli , Turkey
| | - Selçuk Yüksel
- b Pamukkale University School of Medicine , Department of Pediatric Rheumatology , Denizli , Turkey
| | - Nuriye Ünal Şahin
- c National Reference Laboratory for Respiratory Pathogens, Microbiology Reference Laboratories Department, Public Health Institution of Turkey , Ankara , Turkey
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Facchini L, Lucchesi M, Stival A, Roperto RM, Melosi F, Materassi M, Farina S, Tintori V, de Martino M, Sardi I. Role of eculizumab in a pediatric refractory gemcitabine-induced thrombotic microangiopathy: a case report. J Med Case Rep 2017; 11:209. [PMID: 28747219 PMCID: PMC5530476 DOI: 10.1186/s13256-017-1373-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 07/02/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The incidence of gemcitabine-induced hemolytic uremic syndrome has already been described in adults. Several approaches have been employed in the treatment of gemcitabine-induced hemolytic uremic syndrome with different outcomes. One of the most promising agents is eculizumab, which is a monoclonal antibody directed against C5 complement protein. CASE PRESENTATION We reported the case of a 3-year-old white boy with medulloblastoma who underwent high-dose chemotherapy and craniospinal irradiation. Afterwards he started maintenance chemotherapy with gemcitabine and oxaliplatin. After five courses he presented a progressive clinical worsening, which resulted in a systemic thrombotic microangiopathy. Initially he was treated with rituximab without clinical improvement. Therefore he started therapy with repeated cycles of eculizumab. After seven infusions he showed a gradual improvement and finally a complete remission of gemcitabine-induced hemolytic uremic syndrome. CONCLUSIONS Eculizumab prevents serious complement-mediated vascular damage for chemotherapy-induced thrombotic microangiopathy in pediatric cases.
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Affiliation(s)
- Ludovica Facchini
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Viale G. Pieraccini 24, 50139, Florence, Italy
| | - Maurizio Lucchesi
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Viale G. Pieraccini 24, 50139, Florence, Italy
| | - Alessia Stival
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Viale G. Pieraccini 24, 50139, Florence, Italy
| | - Rosa Maria Roperto
- Nephrology Unit, Meyer Children's Hospital, University of Florence, Florence, Italy
| | | | - Marco Materassi
- Nephrology Unit, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Silvia Farina
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Viale G. Pieraccini 24, 50139, Florence, Italy
| | - Veronica Tintori
- Transplantation Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences, University of Florence, Meyer Children's Hospital, Florence, Italy
| | - Iacopo Sardi
- Neuro-Oncology Unit, Department of Pediatric Oncology, Meyer Children's Hospital, Viale G. Pieraccini 24, 50139, Florence, Italy.
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Noronha N, Costa FD, Dias A, Dinis A. Complement factor B mutation-associated aHUS and myocardial infarction. BMJ Case Rep 2017; 2017:bcr-2017-219716. [PMID: 28710236 DOI: 10.1136/bcr-2017-219716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 6-month-old female infant was referred with a 3-day history of low-grade fever, slight nasal congestion and rhinorrhoea. On admission, the clinical findings were unremarkable and she was discharged home. However, she became progressively more listless with a decreased urine output and was once again seen in the emergency department. Analytically she was found to have metabolic acidosis, hyperkalaemia, thrombocytopaenia, anaemia and schistocytes in the peripheral blood smear. Based on these findings, the diagnosis of haemolyticâ-uremic syndrome was made. A few hours postadmission, there was an abrupt clinical deterioration. She went into cardiorespiratory arrest and she was successfully resuscitated. An ST-segment elevation was noted on the ECG monitor and the troponin I levels were raised, suggesting myocardial infarction. Despite intensive supportive therapy, she went into refractory shock and died within 30 hours.
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Affiliation(s)
- Natália Noronha
- Serviáo de Cuidados Intensivos Pediátricos, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Filipa Dias Costa
- Serviáo de Cuidados Intensivos Pediátricos, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Andrea Dias
- Serviáo de Cuidados Intensivos Pediátricos, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Portugal
| | - Alexandra Dinis
- Serviáo de Cuidados Intensivos Pediátricos, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Portugal
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Andries G, Karass M, Yandrapalli S, Linder K, Liu D, Nelson J, Pawar R, Chugh S. Atypical hemolytic uremic syndrome in first trimester pregnancy successfully treated with eculizumab. Exp Hematol Oncol 2017; 6:4. [PMID: 28101432 PMCID: PMC5237177 DOI: 10.1186/s40164-017-0064-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 01/06/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Atypical hemolytic uremic syndrome is a rare disorder which is known to cause acute thrombotic microangiopathy during pregnancy with poor maternal and fetal outcomes. Atypical hemolytic uremic syndrome is caused mostly by dysregulation of alternative complement pathway secondary to genetic mutations. Most of the cases reported have been in the post-partum period. We report a rare case of a patient who presents with thrombotic microangiopathy in the first trimester of her eleventh pregnancy and was successfully treated with eculizumab. CASE PRESENTATION A 30-year-old woman presented at 10 weeks of gestation with hypertension, hemolytic anemia, thrombocytopenia, and acute kidney injury, consistent with thrombotic microangiopathy. She was managed initially with daily plasmapheresis. However, her kidney function did not recover, requiring hemodialysis. ADAMTS13 activity was later found to be within normal limit, hence diagnosis of atypical hemolytic uremic syndrome was strongly considered at that time and she was immediately treated with anti-C5 humanized monoclonal antibody (eculizumab). The patient responded well (resolution of thrombotic microangiopathy and recovery of renal function) to eculizumab, with continued remission after discharge and successfully delivered a healthy baby at term without any peripartum complications. CONCLUSION Early recognition of atypical hemolytic uremic syndrome is often difficult as several other conditions also manifest as thrombotic microangiopathy during pregnancy, causing delay in initiating appropriate treatment. Our case suggests that treatment of atypical hemolytic uremic syndrome in early trimester of pregnancy with eculizumab results in good outcome to mother and fetus.
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Affiliation(s)
- Gabriela Andries
- Division of Internal Medicine, New York Medical College, Westchester Medical Center, Valhalla, NY 10595 USA
| | - Michael Karass
- Division of Internal Medicine, New York Medical College, Westchester Medical Center, Valhalla, NY 10595 USA
| | - Srikanth Yandrapalli
- Division of Internal Medicine, New York Medical College, Westchester Medical Center, Valhalla, NY 10595 USA
| | - Katherine Linder
- Division of Internal Medicine, New York Medical College, Westchester Medical Center, Valhalla, NY 10595 USA
| | - Delong Liu
- Division of Hematology and Oncology, New York Medical College, Westchester Medical Center, Valhalla, NY 10595 USA
| | - John Nelson
- Division of Hematology and Oncology, New York Medical College, Westchester Medical Center, Valhalla, NY 10595 USA
| | - Rahul Pawar
- Division of Nephrology, New York Medical College, Westchester Medical Center, Valhalla, NY 10595 USA
| | - Savneek Chugh
- Division of Nephrology, New York Medical College, Westchester Medical Center, Valhalla, NY 10595 USA
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