Highlights
- •Drug-induced thrombotic microangiopathy (DI-TMA) is a rare complication caused by various drugs.
- •DI-TMA is usually managed by drug discontinuation and supportive measures alone.
- •Studies on DI-TMA management are scarce, and whether complement-inhibition is effective is unknown.
- •In our scoping review, eculizumab was effective to achieve recovery in severe or refractory DITMA.
Abstract
Drug-induced TMA (DI-TMA) is a thrombotic microangiopathy (TMA) caused by certain
drugs, usually managed by drug discontinuation and supportive measures. Data on the
use of complement-inhibition with eculizumab in DI-TMA is scarce, and its benefit
in cases of severe or refractory DI-TMA is unclear. We conducted a comprehensive search
in PubMed, Embase and MEDLINE databases (2007–2021). We included articles that reported
on DI-TMA patients treated with eculizumab and its clinical outcomes. All other causes
of TMA were excluded. We evaluated the outcomes of hematologic recovery, renal recovery,
and a composite of both (complete TMA recovery). 35 studies fulfilled our search criteria,
which included 69 individual cases of DI-TMA treated with eculizumab. Most cases were
secondary to chemotherapeutic agents, and the most implicated drugs were gemcitabine
(42/69), carfilzomib (11/69), and bevacizumab (5/69). The median number of eculizumab
doses given was 6 (range 1–16). 55/69 (80 %) patients achieved renal recovery, after
28–35 days (5–6 doses). 13/22 (59 %) patients were able to discontinue hemodialysis.
50/68 (74 %) patients achieved complete hematologic recovery after 7–14 days (1–2
doses). 41/68 (60 %) patients met criteria for complete TMA recovery. Eculizumab was
safely tolerated in all cases, and appeared to be effective in achieving both hematologic
and renal recovery in DI-TMA refractory to drug discontinuation and supportive measures,
or with severe manifestations associated with significant morbidity or mortality.
Our findings suggest that eculizumab may be considered as a potential treatment for
severe or refractory DI-TMA that does not improve after initial management, although
larger studies are needed.
Keywords
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Article info
Publication history
Published online: March 02, 2023
Accepted:
February 23,
2023
Received in revised form:
January 16,
2023
Received:
November 15,
2022
Identification
Copyright
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