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Eculizumab Duration aHUS — ESENeph MCQ

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HardGlomerulonephritisEculizumab Duration aHUSESENeph

A 64 kg adult with confirmed atypical haemolytic uraemic syndrome has had a sustained haematological and renal response after 4 months of eculizumab. A less frequent maintenance infusion is preferred. Which NHS-funded option meets NICE TA710 criteria?

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Correct answer: D — Switch to ravulizumab after the established eculizumab response

The best answer is “Switch to ravulizumab after the established eculizumab response”. NICE recommends ravulizumab for people weighing at least 10 kg who are complement-inhibitor naive or whose aHUS has responded to at least 3 months of eculizumab; this patient meets the second route. “Continue eculizumab because prior complement inhibition excludes ravulizumab” is less appropriate because TA710 explicitly includes responders after the minimum eculizumab exposure “Switch to ravulizumab after exactly 12 months of eculizumab” is less appropriate because the NICE minimum is 3 months with evidence of response “Stop complement inhibition because any renal response proves permanent remission” is less appropriate because a response does not itself establish that complement blockade can safely cease “Switch to plasma exchange as routine maintenance” is less appropriate because plasma exchange is not the NICE maintenance alternative described for this responder

Reference: NICE TA710: ravulizumab for atypical haemolytic uraemic syndrome: https://www.nice.org.uk/guidance/ta710/chapter/1-Recommendations