Eculizumab

How it works

It binds complement protein C5, preventing its cleavage to C5a and C5b and thereby blocking formation of the terminal membrane attack complex and complement-mediated cell injury.

Prescribing in practice

• By blocking terminal complement it markedly increases susceptibility to meningococcal disease; vaccinate against Neisseria meningitidis before starting (with antibiotic cover if treatment cannot wait) and counsel on urgent action for fever.
• Patients should carry a safety card; the risk of meningococcal and other encapsulated-organism infection persists throughout treatment.
• It is a high-cost biologic given by intravenous infusion and prescribed within specialist commissioned pathways.

Monitoring

Monitor for signs of infection (especially meningococcal) and haematological and renal response to treatment.

Counselling the patient

• You must be vaccinated against meningococcus and carry your patient safety card at all times.
• Seek emergency medical care immediately for fever, severe headache, neck stiffness or a rash.
• Do not miss scheduled infusions, as the disease can relapse.

Evidence & guidelines

Eculizumab is the established complement-inhibiting therapy for atypical haemolytic uraemic syndrome and is recommended within specialist commissioning, with mandatory meningococcal risk-mitigation reflected in MHRA guidance.