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Prophylactic amoxicillin for the prevention of meningococcal infection in infants with atypical hemolytic uremic syndrome under treatment with eculizumab: a report of two cases

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Abstract

Eculizumab, a humanized monoclonal antibody to complement C5, is a therapeutic drug for atypical hemolytic–uremic syndrome (aHUS) that inhibits the terminal pathway of complement. Patients on eculizumab therapy may become more susceptible to infection with capsule-forming bacteria, including meningococci. Therefore, meningococcal vaccination is required for patients who are on eculizumab therapy. However, the means to prevent meningococcal infection in infants who cannot be vaccinated with the available meningococcal vaccine have not yet been established internationally. In two infants with aHUS at 4–5 months after birth, prophylactic oral amoxicillin was administered, and meningococcal infection was not detected during the period between the initiation of eculizumab therapy and the administration of meningococcal vaccine. Neither adverse events related to amoxicillin nor thrombotic microangiopathy occurred during the treatment. Thus, oral administration of amoxicillin may be effective for preventing meningococcal infection under treatment with eculizumab in infants who have not received meningococcal vaccination.

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References

  1. Soliris [Package insert]. Tokyo, Japan: Alexion Pharma; 2017. https://www.soliris.jp/common/pdf/Soliris_Tempu_Bunsho.pdf. Accessed 27 Aug 2019. [Japanese].

  2. Fukusumi M, et al. National surveillance for meningococcal disease in Japan 1999 2014. Vaccine. 2016;34(4068):4071.

    Google Scholar 

  3. Menactra vaccine [Prescribing Information]. Swiftwater, PA: Sanofi Pasteur; 2018. https://www.vaccineshoppe.com/image.cfm?pi=589-05&image_type=product_pdf. Accessed 27 Aug 2019.

  4. American Academy of Pediatrics. Red Book 29th; 2012. Report of the Committee on Infectious Diseases. Available from: https://redbook.solutions.aap.org/DocumentLibrary/RB12_interior.pdf. Accessed 27 Aug 2019.

  5. Advisory Committee on Immunization Practices (ACIP). Vaccine-Specific Recommendations; 2013. Available from: https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/index.html. Accessed 27 Aug 2019.

  6. Recommended Immunization Schedules for Persons Aged 0. Through 18 Years United States, 2016. CDC, Advisory Committee on Immunization Practices recommendations. https://www.cdc.gov/vaccines/schedules/downloads/past/2016-child.pdf. Accessed 27 Aug 2019.

  7. Vaccination/Infection Control Committee of the Japan Pediatric Society. Voluntary vaccinations in children (less than 15 years of age); September 2017. Available from: https://www.jpeds.or.jp/uploads/files/20170924ninni.pdf. Accessed 27 Aug 2019. (Japanese).

  8. Terano C, Ishikura K, Hamada R, Yoshida Y, Kubota W, Okuda Y, et al. Practical issues in using eculizumab for children with atypical haemolytic uraemic syndrome in the acute phase: a review of four patients. Nephrology (Carlton). 2018;23:539–45.

    Article  Google Scholar 

  9. Ohta T, Urayama K, Tada Y, Furue T, Imai S, Matsubara K, et al. Eculizumab in the treatment of atypical hemolytic uremic syndrome in an infant leads to cessation of peritoneal dialysis and improvement of severe hypertension. Pediatr Nephrol. 2015;30:603–8.

    Article  Google Scholar 

  10. Ito N, Hataya H, Saida K, Amano Y, Hidaka Y, Motoyoshi Y, et al. Efficacy and safety of eculizumab in childhood atypical hemolytic uremic syndrome in Japan. Clin Exp Nephrol. 2016;20:265–72.

    Article  CAS  Google Scholar 

  11. Michaux K, Bacchetta J, Javouhey E, Cochat P, Frémaux-Bacchi V, Sellier-Leclerc AL. Eculizumab in neonatal hemolytic uremic syndrome with homozygous factor H deficiency. Pediatr Nephrol. 2014;29:2415–9.

    Article  Google Scholar 

  12. Ariceta G, Arrizabalaga B, Aguirre M, Morteruel E, Lopez-Trascasa M. Eculizumab in the treatment of atypical hemolytic uremic syndrome in infants. Am J Kidney Dis. 2012;59:707–10.

    Article  CAS  Google Scholar 

  13. Sharma S, Pradhan M, Meyers KE, Le Palma K, Laskin BL. Neonatal atypical hemolytic uremic syndrome from a factor H mutation treated with eculizumab. Clin Nephrol. 2015;84:181–5.

    Article  CAS  Google Scholar 

  14. American Academy of Pediatrics. Immunization and Other Considerations in Immunocompromised Children. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, editors. Red Book: 2018 Report of the Committee on Infectious Diseases. Elk Grove Village, IL: American Academy of Pediatrics; 2018. p. 72–91.

    Google Scholar 

  15. Uemura O, Ishikura K, Gotoh Y, Honda M. Creatinine-based estimated glomerular filtration rate for children younger than 2 years. Clin Exp Nephrol. 2018;22:483–4.

    Article  Google Scholar 

  16. Sánchez-Corral P, González-Rubio C, Rodríguez de Córdoba S, López-Trascasa M. Functional analysis in serum from atypical hemolytic uremic syndrome patients reveals impaired protection of host cells associated with mutations in factor H. Mol Immunol. 2004;41:81–4.

    Article  Google Scholar 

  17. Plotkin SA, Orenstein WA, Offit PA. Meningococcal vaccine. Vaccine. 6th ed. Amsterdam: Elsevier; 2013. p. 388–418.

    Google Scholar 

  18. National Institute of Infectious Diseases and Health Service Division, Health Service Bureau, Ministry of Health, Labour and Welfare. (Special topic) Invasive meningococcal infection, from 2013 to October 2017. Infect Agents Surveill Rep. 2018;39:1–9.

    Google Scholar 

  19. McNamara LA, Topaz N, Wang X, Hariri S, Fox L, MacNeil JR. High risk for invasive meningococcal disease among patients receiving eculizumab (Soliris) despite receipt of meningococcal vaccine. MMWR Morb Mortal Wkly Rep. 2017;66:734–7.

    Article  Google Scholar 

  20. David LH. Meningococcal infection. Control of communicable diseases manual. 19th ed. APHA: 2013. 45–23.

  21. Loirat C, Fakhouri F, Ariceta G, Besbas N, Bitzan M, Bjerre A, et al. An international consensus approach to the management of atypical hemolytic uremic syndrome in children. Pediatr Nephrol. 2016;31:15–39.

    Article  Google Scholar 

  22. Menveo (Prescribing Information). Philadelphia, PA: GlaxoSmithKline; 2018. https://www.gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/Prescribing_Information/Menveo/pdf/MENVEO.PDF. Accessed 27 Aug 2019.

  23. MenHibrix [Prescribing Information]. Philadelphia, PA: GlaxoSmithKline; 2012. https://www.fda.gov/media/83688/download. Accessed 27 Aug 2019.

  24. Menactra (Prescribing Information). Swiftwater, PA: Sanofi Pasteur; 2011. https://images.procon.org/wp-content/uploads/sites/17/menactra_package_insert.pdf. Accessed 27 Aug 2019.

  25. Menactra (Package insert). Tokyo, Japan: Sanofi; 2018. https://e-mr.sanofi.co.jp/-/media/EMS/Conditions/eMR/di/tenpu/menactra.pdf. Accessed 27 Aug 2019. (Japanese)

  26. Kise T, Yoshimura H, Fukuyama S, Uehara M. Invasive Meningococcal Disease during an Eculizumab Treatment for Atypical Hemolytic Uremic Syndrome Despite a Neisseria Meningococcal Vaccine. J Jpn Pediatr Soc. 2017;121:1719–23 (Japanese).

    Google Scholar 

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Acknowledgements

We deeply appreciate Dr. Masanori Matsumoto, Department of Blood Transfusion Medicine, Nara Medical University, Japan, for his contribution to the analysis of ADMTS13. We are grateful to Dr. Yoko Yoshida, Hideki Kato, and Masaomi Nangaku, The Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Japan for their contribution to sheep erythrocyte hemolysis test, anti-factor H antibody assay, and gene analysis. We also thank The Japanese Association for Complement Research for their contribution to complement test and gene analysis which were financially supported by Alexion GK as a company-sponsored research. Kae Uetani of Statcom Co., Ltd., Tokyo, Japan, provided assistance in preparing the manuscript funded by Alexion Pharma GK.

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Authors and Affiliations

  1. Department of Nephrology, Aichi Children’s Health and Medical Center, 7-426 Morioka-cho, Obu, Aichi, 474-8710, Japan

    Kazuki Tanaka, Naoya Fujita & Satoshi Hibino

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  1. Kazuki Tanaka
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  2. Naoya Fujita
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  3. Satoshi Hibino
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Correspondence to Kazuki Tanaka.

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All the authors have declared no competing interest.

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This article does not contain any studies with human participants performed by any of the authors. The publication of this report was approved by our institutional review board (no. 2019078).

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Oral consent was obtained from the parents of the patients for the publication of this case report.

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Tanaka, K., Fujita, N. & Hibino, S. Prophylactic amoxicillin for the prevention of meningococcal infection in infants with atypical hemolytic uremic syndrome under treatment with eculizumab: a report of two cases. CEN Case Rep 9, 247–251 (2020). https://doi.org/10.1007/s13730-020-00465-x

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  • DOI: https://doi.org/10.1007/s13730-020-00465-x

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