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Zhou S, Dong X, Chen C, Ma L, Wu Y, Zhou Y, Cui Y. Efficacy and Safety of Eculizumab for Paroxysmal Nocturnal Hemoglobinuria: A Systematic Review and Meta-Analysis. J Pediatr Hematol Oncol 2021; 43:203-210. [PMID: 33902068 DOI: 10.1097/mph.0000000000002178] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/22/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Eculizumab is indicated for the treatment of paroxysmal nocturnal hemoglobinuria (PNH). This study aimed to evaluate the efficacy and safety of eculizumab in patients with PNH. METHODS PubMed, EMBASE, The Cochrane Library, and ClinicalTrials.gov were searched for prospective interventional studies treating PNH with eculizumab. The primary outcome was the change in lactate dehydrogenase (LDH) levels, whereas secondary outcomes included the change in hemoglobin (Hb) levels, transfusion rates, and adverse drug events. RESULTS Patients (n=235) from 6 studies were included in this meta-analysis. LDH and Hb levels and transfusion rates decreased significantly at 12, 26 weeks, 12, 15, and >15 months. The most frequent adverse events included nasopharyngitis (effect size [ES]: 0.53; 95% confidence intervals [CI]: 0.47 to 0.60; P=0.00), headache (ES: 0.47; 95% CI: 0.25 to 0.69; P=0.00), upper respiratory tract infection (ES: 0.37; 95% CI: 0.27 to 0.46; P=0.00), nausea (ES: 0.31; 95% CI: 0.24 to 0.38; P=0.00), fatigue, diarrhea, cough, pyrexia, abdominal pain, pain in extremities, and contusion. CONCLUSION Eculizumab is an effective and well-tolerated treatment for patients with PNH. It is effective at decreasing LDH levels and transfusion rates while increasing Hb levels. Further studies are needed to explore the safety of eculizumab.
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Affiliation(s)
- Shuang Zhou
- Departments of Pharmacy
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Xiu Dong
- Departments of Pharmacy
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Chaoyang Chen
- Departments of Pharmacy
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Lingyun Ma
- Departments of Pharmacy
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Ye Wu
- Pediatrics, Peking University First Hospital
| | - Ying Zhou
- Departments of Pharmacy
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
| | - Yimin Cui
- Departments of Pharmacy
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing, China
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Rosa J, Arruda A, Rodrigues AL, Soares MR. Paroxysmal Nocturnal Hemoglobinuria: Case Report of a Rare Cause of Thrombosis in the Pediatric Age. J Pediatr Hematol Oncol 2021; 43:e240-e242. [PMID: 31842179 DOI: 10.1097/mph.0000000000001701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 11/26/2019] [Indexed: 11/26/2022]
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired life-threatening disorder that is extremely rare in the pediatric age. Patients with PNH may present a wide range of clinical manifestations. In most cases, the severity is associated with the size of the PNH clones; yet, some patients can be asymptomatic with a large clone. Thrombosis occurs less frequently as a presenting symptom, but it is considered the leading cause of mortality. In this article, we describe a case of PNH in a pediatric patient, complicated with venous thrombosis and with portal hypertension, associated with gastroesophageal varices at the time of diagnosis.
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Affiliation(s)
- Joana Rosa
- Pediatric Department, Hospital of Divino Espírito Santo of Ponta Delgada, EPER, São Miguel Island, Azores, Portugal
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Abstract
Introduction: Eculizumab, which is indicated to treat patients with paroxysmal nocturnal hemoglobinuria (PNH), is proven to decrease intravascular hemolysis and thrombosis and improve survival. Ravulizumab is a long-acting, second-generation complement component 5 (C5) inhibitor designed to alleviate the burden of the eculizumab treatment schedule and reduce the frequency of breakthrough hemolysis. As the clinical benefits of these treatments have been emphasized, their safety also should be considered. Areas covered: This article reviews safety data for the current approved PNH treatments from published articles about eculizumab and ravulizumab in patients with PNH. Special settings (pregnancy, pediatrics, long-term safety of continued eculizumab treatment, and extravascular hemolysis) are also discussed. Expert opinion: In phase 3 trials, eculizumab and ravulizumab were found to be safe and well tolerated. In addition, 10 years of experience with eculizumab provided evidence that mitigates initial concerns about infectious events. However, to minimize meningococcal infections, vaccination and close monitoring remain essential. Because extravascular hemolysis limits eculizumab efficacy in some patients, continued investigation of proximal complement inhibitors is warranted to obviate this mechanism. Long-term safety data for ravulizumab treatment are needed.
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Affiliation(s)
- Sung-Eun Lee
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea
| | - Jong Wook Lee
- Department of Hematology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea
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Lebreton C, Bacchetta J, Dijoud F, Bessenay L, Fremeaux-Bacchi V, Sellier-Leclerc AL. C3 glomerulopathy and eculizumab: a report on four paediatric cases. Pediatr Nephrol 2017; 32:1023-1028. [PMID: 28236143 DOI: 10.1007/s00467-017-3619-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 11/18/2016] [Accepted: 12/06/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Eculizumab may be used to treat C3-glomerulopathy (C3G), a rare but severe glomerular disease. DIAGNOSIS AND TREATMENT Patients 1, 2 and 3 were diagnosed with nephritic syndrome with alternative complement pathway activation (low C3, C3Nef-positive) and C3G at the age of 9, 13 and 12 years, respectively. Treatment with eculizumab normalized proteinuria within 1, 2 and 7 months, respectively. Proteinuria relapsed when eculizumab was withdrawn, but the re-introduction of eculizumab normalized proteinuria. Patient 4 was diagnosed with C3G at 9 years of age, with progression to end-stage renal disease within 2 years, followed by a first renal transplantation (R-Tx) with early disease recurrence and graft loss within 39 months. After a second R-Tx, she rapidly presented with biological and histological recurrence: therapy with eculizumab was started, with no effect on proteinuria after 5 months, in a complex clinical setting (i.e. association of C3G recurrence, humoral rejection and BK nephritis). Eculizumab was withdrawn due to multiple viral reactivations, but the re-introduction of the drug a few months later enabled a moderate decrease in proteinuria. CONCLUSION These cases illustrate the efficacy of eculizumab, at least on native kidneys, in paediatric C3G. However, larger international studies are warranted to confirm the benefit and safety of eculizumab therapy.
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Affiliation(s)
- Célia Lebreton
- Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Centre de Référence des Maladies Rénales Rares Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron, France
| | - Justine Bacchetta
- Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Centre de Référence des Maladies Rénales Rares Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron, France.,Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France
| | - Frédérique Dijoud
- Faculté de Médecine Lyon Est, Université Lyon 1, Lyon, France.,Laboratoire d'Anatomopathologie, Groupe Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - Lucie Bessenay
- Service de Pédiatrie, CHU Clermont Ferrand, Clermont Ferrand, France
| | - Véronique Fremeaux-Bacchi
- Laboratoire d'Immunologie, Hôpital Georges Pompidou, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Anne Laure Sellier-Leclerc
- Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Centre de Référence des Maladies Rénales Rares Hôpital Femme Mère Enfant, Hospices Civils de Lyon, 59 boulevard Pinel, 69677, Bron, France.
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Experience with the Implementation of Clinical Pharmacy Services and Processes in a University Hospital in Belgium. Drugs Aging 2016; 33:189-97. [PMID: 26922733 DOI: 10.1007/s40266-016-0356-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This article summarizes the experience with the development of clinical pharmacy services in the Ghent University Hospital in Belgium. Implementation of clinical pharmacy services in Belgian hospitals has not been evident because these activities were initially not structurally financed. The aim is to describe the strengths and weaknesses of the clinical pharmacy development process, and the milestones that enhanced the progress. Furthermore, the organisation of clinical pharmacy in the Ghent University Hospital is explained, including back- and front-office activities, seamless pharmaceutical care and medication safety improvement. Some working methods, procedures and tools are explained for different clinical pharmacy services. In particular, the clinical pharmacy projects for geriatric patients as well as the preparation of clinical pharmacy services for the accreditation process are explained. We also reflect on the organisation model and the future development of clinical pharmacy, taking into consideration facilitators and potential barriers.
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Oshiro H, Goi K, Akahane K, Inukai T, Sugita K. Effective eculizumab therapy followed by BMT in a boy with paroxysmal nocturnal hemoglobinuria. Pediatr Int 2015; 57:e27-9. [PMID: 25868955 DOI: 10.1111/ped.12522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 08/13/2014] [Accepted: 09/09/2014] [Indexed: 11/27/2022]
Abstract
A 9-year-old boy with paroxysmal nocturnal hemoglobinuria/aplastic anemia syndrome (PNH/AA) developed hemolytic crisis after receiving immunosuppressive therapy. Eculizumab dramatically relieved the signs and symptoms and then he safely underwent unrelated bone marrow transplantation, suggesting the feasibility and effectiveness of eculizumab before stem cell transplantation in children with PNH/AA in hemolytic crisis.
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Affiliation(s)
- Hiroko Oshiro
- Department of Pediatrics, School of Medicine, University of Yamanashi, Yamanashi, Japan
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Reiss UM, Schwartz J, Sakamoto KM, Puthenveetil G, Ogawa M, Bedrosian CL, Ware RE. Efficacy and safety of eculizumab in children and adolescents with paroxysmal nocturnal hemoglobinuria. Pediatr Blood Cancer 2014; 61:1544-50. [PMID: 24777716 DOI: 10.1002/pbc.25068] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 03/24/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND Paroxysmal nocturnal hemoglobinuria (PNH) is rare in children, but represents a similarly serious and chronic condition as in adults. Children with PNH frequently experience complications of chronic hemolysis, recurrent thrombosis, marrow failure, serious infections, abdominal pain, chronic fatigue, and decreased quality of life with reduced survival. The terminal complement inhibitor eculizumab is proven to be effective and safe in adults and approved by the FDA for treatment of PNH. PROCEDURE This 12-week, open-label, multi-center phase I/II study evaluated pharmacokinetics, pharmacodynamics, efficacy, and safety in seven children with PNH 11-17 years of age. Eculizumab was intravenously administered at 600 mg weekly for 4 weeks, 900 mg in week 5, and 900 mg every 2 weeks thereafter (http://clinicaltrials.gov NCT00867932). RESULTS Eculizumab therapy resulted in complete and sustained inhibition of hemolysis in all participants with a reduction of lactate dehydrogenase to normal levels. All hematological parameters stabilized. No definitive, study drug-related adverse events were observed. Only one severe SAE of hospitalization due to aplastic anemia occurred, which was not study drug-related. CONCLUSION Eculizumab appears to be a safe and effective therapy for children with PNH.
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Affiliation(s)
- Ulrike M Reiss
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee
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Schejbel L, Fadnes D, Permin H, Lappegård KT, Garred P, Mollnes TE. Primary complement C5 deficiencies – Molecular characterization and clinical review of two families. Immunobiology 2013; 218:1304-10. [DOI: 10.1016/j.imbio.2013.04.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 04/22/2013] [Accepted: 04/26/2013] [Indexed: 10/26/2022]
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