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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 2 مورد

Evaluation and prevention of infections associated with complement-5 (C5) inhibitors

Evaluation and prevention of infections associated with complement-5 (C5) inhibitors
Medication Associated infections* Pre-treatment management Medical prophylaxis

Eculizumab

Ravulizumab

Zilucoplan

Pozelimab

Crovalimab
  • Serious infections due to encapsulated bacteria (Neisseria meningitidis [any serogroup, including nongroupable strains], Streptococcus pneumoniae, Haemophilus influenzae type b)
  • Aspergillus spp infections have occurred in immunocompromised and neutropenic patients receiving eculizumab
  • Meningococcal vaccination (against serotypes A, B, C, W, and Y): Complete primary vaccine series or administer booster vaccine (if indicated) at least 2 weeks prior to starting treatment, unless the risk of delaying treatment outweighs the risk of developing meningococcal diseaseΔ
  • Pneumococcal vaccination: Administer pneumococcal vaccine (as indicated for patients at high risk of disease) at least 2 weeks prior to starting treatment, unless the risk of delaying treatment outweighs the risk of developing pneumococcal diseaseΔ
  • Update all routine age-appropriate vaccinations (especially Hib) before initiating C5 inhibitor or once the patient is clinically stable if treatment is needed urgently◊
  • Ensure control/resolution of any serious active infections with an encapsulated bacteria (eg, N. meningitidis) prior to initiating therapy

If meningococcal and/or pneumococcal vaccination is not completed 2 weeks prior to initiating a C5 inhibitor, antibiotic prophylaxis (eg, penicillin) against meningococcal and/or pneumococcal disease must be provided until 2 weeks after vaccination series has been completed.§

Many experts also suggest prophylaxis against meningococcal disease for the duration of C5 complement inhibitor treatment, in addition to vaccination.[1,2]

This table serves as an overview of how to evaluate for and prevent infections in patients starting and/or taking complement-5 (C5) inhibitors. These agents inhibit C5 and reduce the number of terminal complement components (C5b-9) that form the membrane attack complex, leading to impaired cytolysis of encapsulated bacteria. Infections highlighted in bold warrant extra consideration.

Since neither vaccination nor antimicrobial prophylaxis can be expected to prevent all cases of infection in complement inhibitor recipients, patients should be educated about the risk of infection and encouraged to seek medical care immediately if any symptoms of meningococcal disease (eg, fever, headache, altered mentation, rash) or other infections occur.[1]

ACIP: United States Advisory Committee on Immunization Practices; Hib: Haemophilus influenzae type b.

* In addition to the infections listed, typical, common bacterial and viral infections should also be considered in the differential when infection is suspected in a patient taking the specified agent.

¶ Cases of Neisseria gonorrhoeae have been reported. Patients at risk for gonorrhea should be counseled on the increased risk with C5 inhibitors and the preventive strategies available.

Δ Vaccination should be completed in accordance with current ACIP recommendations for patients receiving a C5 inhibitor. For such patients, ACIP recommendations differ from the vaccine schedules included in United States prescribing information.[2-4] Tables of meningococcal and pneumococcal vaccine recommendations for persons at increased risk of disease are available separately in UpToDate. If vaccination cannot occur at least 2 weeks prior to therapy, it should be completed as soon as possible.

◊ Other vaccines indicated for immunocompromised individuals (eg, recombinant zoster vaccine) should also be administered once the individual is clinically stable.

§ For specific recommendations, refer to UpToDate content on prevention of meningococcal disease in patients receiving C5 inhibitors.

References:
  1. McNamara LA, Topaz N, Wang X, et al. High risk for invasive meningococcal disease among patients receiving eculizumab (Soliris) despite receipt of meningococcal vaccine. MMWR Morb Mortal Wkly Rep 2017; 66:734.
  2. Mbaeyi SA, Bozio CH, Duffy J, et al. Meningococcal vaccination: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020. MMWR Recomm Rep 2020; 69:1.
  3. Altered immunocompetence. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/imz-best-practices/altered-immunocompetence.html (Accessed on January 31, 2025).
  4. Kobayashi M, Pilishvili T, Farrar JL, et al. Pneumococcal vaccine for adults aged ≥19 years: Recommendations of the Advisory Committee on Immunization Practices, United States, 2023. MMWR Recomm Rep 2023; 72:1.

With additional data from:

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