Risk management of neuroinfection by complement inhibitor treatment

Abstract

Eculizumab, a terminal complement inhibitor, is licensed for treatments of paroxysmal nocturnal hemoglobinuria, atypical hemolytic uremic syndrome, myasthenia gravis, and Neuromyelitis Optica Spectrum Disorders, which were life–threatening hematologic and neurological diseases. The Food and Drug Administration in US approved prescribing information includes a warning regarding increased risk for meningococcal disease in eculizumab recipients.

Taking of eculizumab is associated with a 1,000 to 2,000 fold increased incidence of meningococcal disease. Administration of meningococcal vaccines is recommended for patients receiving eculizumab before the treatment. 16 patients of meningococcal disease were identified in eculizumab recipients in the US during 2008 to 2016, and 4 patients also identified in Japan. In Japan, two patients were died, rest two patients were completely recovered by the appropriate antibiotics treatment. Eculizumab recipients remain at risk for meningococcal disease even after receipt of meningococcal vaccines. Initial symptoms of meningococ­cemia are nonspecific, and might include fever, chills, vomiting, and headaches. However, these symptoms can progress to severe illness and death within hours. Health care workers should be careful of suspicion for meningococcal disease in patients taking eculizumab who develop any symptoms consistent with either meningitis or meningococcemia.