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MG – Eculizumab Prerequisite — SCE Neurology MCQ

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HardPeripheral Neuropathy & NeuromuscularMG – Eculizumab PrerequisiteSCE Neurology

A patient with refractory AChR-positive generalised myasthenia gravis is due to start eculizumab in seven days. He has never received meningococcal vaccine. Which prevention plan is appropriate?

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Correct answer: EMenACWY and MenB vaccination with interim antibiotic prophylaxis before eculizumab

The best answer is “MenACWY and MenB vaccination with interim antibiotic prophylaxis before eculizumab”. Terminal-complement blockade creates a major meningococcal risk; both ACWY and B vaccination are required, and when the two-week interval cannot be achieved, licensed risk mitigation includes appropriate antibiotic prophylaxis. “Give pneumococcal vaccine alone and start eculizumab immediately” is less appropriate because pneumococcal vaccination does not cover the defining meningococcal susceptibility “Start eculizumab without vaccination because complement blockade prevents inflammation” is less appropriate because complement blockade impairs killing of Neisseria rather than protecting against it “Give a live meningococcal vaccine after the first eculizumab infusion” is less appropriate because the relevant vaccines are not a post-infusion live-vaccine strategy “Use hepatitis-B vaccination as the sole infection precaution” is less appropriate because hepatitis-B screening may be relevant to other immunotherapies but does not mitigate C5-blockade meningococcal risk

Reference: Soliris 300 mg concentrate for solution for infusion: SmPC. https://www.medicines.org.uk/emc/product/362/smpc