The Extended Use of Eculizumab in Pregnancy and Complement Activation-Associated Diseases Affecting Maternal, Fetal and Neonatal Kidneys-The Future Is Now?

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Stefanovic , V 2019 , ' The Extended Use of Eculizumab in Pregnancy and Complement Activation-Associated Diseases Affecting Maternal, Fetal and Neonatal Kidneys-The Future Is Now? ' , Journal of clinical medicine , vol. 8 , no. 3 , 407 . https://doi.org/10.3390/jcm8030407

Title: The Extended Use of Eculizumab in Pregnancy and Complement Activation-Associated Diseases Affecting Maternal, Fetal and Neonatal Kidneys-The Future Is Now?
Author: Stefanovic, Vedran
Contributor: University of Helsinki, Department of Obstetrics and Gynecology
Date: 2019-03-24
Language: eng
Number of pages: 20
Belongs to series: Journal of clinical medicine
ISSN: 2077-0383
URI: http://hdl.handle.net/10138/301569
Abstract: Excessive complement activation is involved in the pathogenesis of many diseases and the kidney is an organ with particular susceptibility to complement-mediated injury. Apart from paroxysmal nocturnal hemoglobinuria (PNH) and atypical hemolytic uremic syndrome (aHUS), there are several other diseases with clear evidence of complement activation affecting both maternal and fetal kidneys during pregnancy and causing long-term adverse outcomes. Several novel drugs have been recently developed for blocking the complement cascade, including purified plasma proteins, new monoclonal antibodies, recombinant proteins, small molecules, and small interfering RNA agents. Eculizumab, the humanized monoclonal IgG2/4-antibody targeting C5 was approved by the United States Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for treatment of two rare diseases: PNH in 2007 and aHUS in 2011. There is an increasing number of publications of successful use of eculizumab for off-label indications, e.g., in pregnant women with antiphospholipid syndrome, sickle-cell anemia, and HELLP syndrome. These severe diseases are associated with both high maternal and fetal morbidity and mortality rate and substantial prematurity. Eculizumab has considerably improved overall outcome of patients with PNH and aHUS, enabling safe pregnancy for many women. Prolongation of pregnancy and the use of eculizumab, even for only a few weeks, may protect not only maternal renal function, but also alleviate acute and long-term renal consequences of prematurity in offspring.
Subject: eculizumab
pregnancy
premature birth
paroxysmal nocturnal hemoglobinuria
atypical hemolytic uremic syndrome
antiphospholipid syndrome
sickle-cell anemia
HELLP
fetal kidney development
complement activation
HEMOLYTIC-UREMIC SYNDROME
SICKLE-CELL-DISEASE
PAROXYSMAL-NOCTURNAL HEMOGLOBINURIA
ELEVATED LIVER-ENZYMES
PERINATAL OUTCOMES
HELLP-SYNDROME
INHIBITOR ECULIZUMAB
ADULT PATIENTS
UNITED-STATES
FOLLOW-UP
3123 Gynaecology and paediatrics
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