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3303 Eculizumab Is An Effective Long-Term Treatment In Patients with Atypical Hemolytic Uremic Syndrome (aHUS) Previously Receiving Chronic Plasma Exchange/Infusion (PE/PI): Extension Study ResultsClinically Relevant Abstract

Program: Oral and Poster Abstracts
Session: 311. Disorders of Platelet Number or Function: Poster III
Monday, December 12, 2011, 6:00 PM-8:00 PM
Hall GH (San Diego Convention Center)

Christoph Licht, MD1*, Petra Muus, MD, PhD2, Christophe Legendre, MD3*, Kenneth W Douglas, MD4*, Maryvonne Hourmant, MD5*, Yahsou Delmas, MD6*, Maria Herthelius, MD7*, Antonella Trivelli, MD8*, Timothy H. J. Goodship, MD9*, Camille L Bedrosian, MD10 and Chantal Loirat, MD11*

1The Hospital for Sick Children, Division of Nephrology, Toronto, ON, Canada
2Department of Hematology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
3Université Paris Descartes & Hôpital Necker, Paris, France
4SNBTS Clinical Apheresis Unit, Beatson West of Scotland Cancer Centre, Glasgow, Scotland
5CHU Hotel Dieu-Nantes, Nantes, France
6CHU Pellegrin-Bordeaux, Bordeaux, France
7Karolinska University Hospital, Stockholm, Sweden
8Istituto G Gaslini, Genova, Italy
9Newcastle University, Newcastle upon Tyne, England
10Global Clinical Development, Alexion Pharmaceuticals, Inc., Cheshire, CT
11Hôpital Debré, Paris, France

INTRODUCTION: Chronic uncontrolled complement activation drives systemic thrombotic microangiopathy (TMA) and life-threatening complications in aHUS. In the initial 26-wk, phase II trial of eculizumab, (ECU) a terminal complement inhibitor, in pts with aHUS requiring chronic PE/PI for an extended period of time, a statistically significant and sustained suppression of TMA was observed. In addition, no pt required PE/PI, no new dialysis was required and all pts either maintained/improved renal function in the absence of PE/PI (Licht ASN 2011). We report longer follow-up data from this trial.

METHODS: Pts ≥12 yrs with aHUS, receiving chronic PE/PI on an unchanged regimen were enrolled in a controlled, open-label, single-arm, phase II trial. After an 8-week observation period, pts discontinued PE/PI and started ECU (900mg/week for 4 wks, 1200mg at wk 5, then 1200mg q2 wks). Pts received a meningococcal vaccine. Primary endpoint: TMA event-free status defined as ≥12 consecutive wks of stable platelet count, no PE/PI and no new dialysis. Secondary endpoints included TMA intervention rate (no. of PE/PI and new dialysis events/pt/day), renal function, and safety. Pts continued into an extension trial.

RESULTS: Of 20 pts (median age=28 yrs) who received ECU through Wk 26 of the initial trial, 19 pts continued ECU treatment into the extension trial. Mean (SD) duration of ECU treatment was 60 (12) wks at data cut-off. Median time from diagnosis to screening=48 mo (0.66-286). Median time from overt clinical symptoms of aHUS to screening=8.6 mo (1.2-45). Median no. of PE/PI sessions per pt during current clinical presentation=62 (20-230). Median duration of eGFR ≤60 mL/min/1.73m2=180 days (23-485). Six pts had no complement regulatory factor mutation (CRFM) identified. Ongoing treatment with long-term ECU was associated with continued improvements in TMA intervention rate and TMA event-free status and further improvement in renal function (Table). Long-term ECU treatment showed a highly significant time-dependent improvement in eGFR (p<0.0001) with a significant improvement from baseline of 8 mL/min/1.73m2 at 1 yr (p<0.0001). PE/PI or new dialysis was not required with chronic ECU treatment in any pt through Wk 26 or during ongoing long-term ECU therapy (through data cut-off). ECU was similarly effective in pts with/without identified CRFMs. ECU was well tolerated; only 7 pts had adverse events deemed possibly or probably related to drug (mild to moderate in severity).  The extension trial continues.

CONCLUSIONS: Despite PE/PI, >50% of pts with aHUS are expected to die, require dialysis or have permanent renal damage within the first year of diagnosis. In this trial, all pts treated with ECU for a mean duration of >1 year are still alive and none progressed to ESRD or required new dialysis with sustained ECU treatment. Importantly, compared with historical outcomes with chronic PE/PI, initiation of sustained, long-term ECU therapy, without PE/PI, was associated with a highly significant time-dependent improvement in eGFR.  Switching to chronic ECU therapy significantly changed the course of the disease in severe and prolonged renal insufficiency pts, resulting in sustained suppression of TMA. These data further demonstrate ECU to be the new standard of care for aHUS.  

Parameter

Wk 26 ECU Treatment (N=20)

Data cut-off (mean* duration of ECU=60 wks]

(N=20)

TMA event-free status, n

16

17

Median TMA intervention rate

0 (p<0.0001)

0 (p<0.0001)

Improvement in ≥ 1 CKD from BL, n

7

9

≥25% reduction in serum creatinine from BL, n

3

7

Change in eGFR from BL, mL/min/1.73m2

6 (p=0.0003)

8 (p<0.0001)

BL=baseline. *Median (range) duration=62 wks (26-74); n=number of pts; At1 yr.
Significance was tested with two sided signed rank test or repeated measures analyses.

Disclosures: Licht: Alexion: Honoraria, Research Funding. Off Label Use: Eculizumab but as part of clinical controlled trials. Muus: Alexion: Membership on an entity’s Board of Directors or advisory committees, Research Funding. Legendre: Alexion: Research Funding. Douglas: Alexion: Genzyme, but not relevant to current submission, Research Funding. Hourmant: Alexion: Research Funding. Delmas: Alexion: Research Funding. Herthelius: Alexion: Research Funding. Trivelli: Alexion: Research Funding. Goodship: Alexion Pharmaceuticals: Consultancy, Fees as Chief Investigator, Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau. Bedrosian: Alexion: Employment. Loirat: Alexion: Honoraria, Research Funding.

*signifies non-member of ASH