Eculizumab Use in the Postpartum Period for the Treatment of Pregnancy Associated Atypical Hemolytic Uremic Syndrome: A Case Series
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 50
- 试验地点
- 1
- 主要终点
- Maternal mortality
研究概览
简要总结
Eculizumab is a humanized monoclonal IgG antibody against protein C5 that works to inhibit the activation of the terminal complement cascade. The Eculizumab is currently FDA approved for the treatment of Paroxysmal nocturnal hemoglobinuria and atypical hemolytic uremic syndrome (aHUS) and has been shown to improve the quality of life and overall survival in these patients. aHUS is a life-threatening disease of complement mediated thrombotic microangiopathy often triggered by an inciting event, such as an infection or immunocompromised state. Pregnancy has also been identified as an inciting event, with patients most often experiencing aHUS in the postpartum period. Due to its rare nature, pregnancy-associated aHUS is often mistaken for preeclampsia or hemolysis, elevated liver enzyme, low platelet (HELLP) syndrome. As standard treatment for preeclampsia and HELLP syndrome is completion of the pregnancy by expediting delivery of the baby. A missed diagnosis of aHUS can result in delays in treatment, including use of Eculizumab when appropriate; such delay can increase the risk of maternal morbidity and mortality. When aHUS is suspected in the postpartum period, Eculizumab could be initiated early; however, there is limited data on use of Eculizumab in this setting.
详细描述
Overall Objective The aim of this study is compare outcomes of women with suspected postpartum aHUS, stratified by treatment with Eculizumab. Specifically, assess the maternal characteristics, clinical presentation, disease course, treatment strategy, and short and long--term complications among a cohort of women with suspected postpartum aHUS, with analyses stratified by Eculizumab exposure.
Aim 1 Hypothesis: Women with suspected postpartum aHUS treated with Eculizumab have a decreased length of hospital stay and a decreased incidence of adverse maternal outcomes when compared to those women with postpartum aHUS not treated with Eculizumab.
Aim 2 Hypothesis: Women with postpartum aHUS treated with Eculizumab have low rates of adverse maternal or neonatal events when followed up to 6 months after delivery.
METHODOLOGY Study Type: Retrospective cohort study Study population: Postpartum patients meeting diagnostic criteria for pregnancy associated aHUS between January 2009 and May 2016 in Colombia. This study cohort will be stratified into two groups: 1) women with suspected postpartum aHUS treated with Eculizumab and; 2) women meeting diagnostic criteria for postpartum aHUS that did not receive treatment with Eculizumab. The investigators chose a start date of 2009 because this was the year that Eculizumab was approved by the National Institute of Food and Drug Monitoring (INVIMA) for use in Paroxysmal Nocturnal Hemoglobinuria (PNH). Eculizumab was subsequently approved for use in aHUS in 2011.In addition, in the same period of time will identify a cohort of women diagnosed with pregnancy associated with HUS in Colombia who did not receive treatment with Eculizumabse.
Unit of analysis: The medical data of patients who meet the inclusion criteria for the study, ie, postpartum aHUS are summarized. For the group of women treated with Eculizumab, and who continue to receive such therapy on an outpatient basis after hospital discharge, the investigators will abstract follow up data up to 6 months postpartum. For missing data that is not readily available in the medical chart the investigators will utilize research assistants, or members of the study team, to contact study subjects or the treating provider to obtain additional information.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 14 Years 至 49 Years（Child, Adult）
- 性别
- Female
- 接受健康志愿者
- 是
入选标准
- •All patients in the postpartum period (within 12 weeks of delivery) that were diagnosed with aHUS by their treating provider or who met standard diagnostic criteria.
- •Subjects meeting diagnostic criteria for aHUS will be included in the study independent of the treatment approach employed by their providers.
- •Those who received at least one dose of Eculizumab for treatment of suspected aHUS will be included, regardless of outcome.
排除标准
- •Patients who did not authorize the use of their information after an informed consent process
- •Patients who their physicians who did not agree to participate in or provide patient information.
结局指标
主要结局
Maternal mortality
时间窗: The data collection will be among the first postpartum day until the sixth month
Death of a woman within 42 days of termination of pregnancy. This is a dichotomy measure
次要结局
- Dosing and number of doses received(The data collection will be among the first postpartum day until the sixth month)
- ICU length of stay(The data collection will be among the first postpartum day until the sixth month)