Eculizumab

Mechanism :

Eculizumab is a humanized monoclonal IgG antibody that binds to complement protein C5, preventing cleavage into C5a and C5b.

Indication :

Treatment of atypical hemolytic uremic syndrome (aHUS) to inhibit complement mediated thrombotic microangiopathy.
Treatment of generalized myasthenia gravis (gMG) in adults who are anti acetylcholine receptor (AchR) antibody positive.
Treatment of paroxysmal nocturnal hemoglobinuria (PNH) to reduce hemolysis.

Contraindications :

Hypersensitivity to eculizumab, murine proteins, or any component of the formulation; unresolved Neisseria meningitidis infection; patients not currently vaccinated against Neisseria meningitidis.

Dosing :

Atypical hemolytic uremic syndrome (aHUS): IV

Infants ≥2 months, Children, and Adolescents:

5 kg to <10 kg: Induction:300 mg weekly for 1 dose; Maintenance: 300 mg at week 2, then 300 mg every 3 weeks.

10 kg to <20 kg: Induction:600 mg weekly for 1 dose; Maintenance: 300 mg at week 2, then 300 mg every 2 weeks.

20 kg to <30 kg: Induction:600 mg weekly for 2 doses; Maintenance: 600 mg at week 3, then 600 mg every 2 weeks.

30 kg to <40 kg: Induction:600 mg weekly for 2 doses; Maintenance: 900 mg at week 3, then 900 mg every 2 weeks.

≥40 kg: Induction:900 mg weekly for 4 doses; Maintenance: 1200 mg at week 5, then 1200 mg every 2 weeks.

Paroxysmal nocturnal hemoglobinuria (PNH): IV

Induction: 600 mg weekly for 4 doses; Maintenance: 900 mg at week 5; then 900 mg every 2 weeks thereafter.

Adverse Effect :

Hypertension, headache, diarrhea, anemia, vomiting, upper respiratory infection, UTI, leukopenia, fatigue, peripheral edema, fever, cough, pharyngolaryngeal pain, vertigo, pain in extremity.

Interaction :

Belimumab: Monoclonal Antibodies may enhance the adverse/toxic effect of Belimumab.
Meningococcal Group B Vaccine: Eculizumab may diminish the therapeutic effect of Meningococcal Group B Vaccine. Meningococcal Group B Vaccine may diminish the therapeutic effect of Eculizumab.
Natalizumab: Immunosuppressants may enhance the adverse/toxic effect of Natalizumab.
Tacrolimus (Topical): May enhance the adverse/toxic effect of Immunosuppressants.
Vaccines (Live): Immunosuppressants may enhance the adverse/toxic effect of Vaccines. Avoid use of live organism vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants.

Hepatic Dose :

Specific guidelines for dosage adjustments in hepatic impairment are not available.