Year: 2025
Type: article
Study design: Observational Study
Abstract: Introduction C5 inhibitor (C5i) therapy markedly increases susceptibility to invasive meningococcal disease (IMD) by blocking the terminal complement pathway essential for defense against Neisseria meningitidis. Vaccination is recommended for all recipients, yet breakthrough infections persist. Antibiotic prophylaxis is not universally endorsed, resulting in variable practices. We aimed to assess whether antibiotic prophylaxis provides additional protection beyond vaccination in C5i-treated patients. Methods The analysis included 124 C5i recipients treated for more than six months. Patients were classified as receiving single protection (vaccination or antibiotic prohylaxis alone) or combined protection (vaccination and continuous antibiotic prphylaxis). Outcomes were analyzed by prescribed and by implemented regimen, the latter accounting for patient adherence to antibiotic prophylaxis. Results 60% of patients were prescribed combined protection. Booster vaccination coverage was low (<40%), and one-quarter of patients did not athere to antibiotic prohylaxis. The overall incidence of IMD was 0.74 cases per 100 patient-years (95% CI: 0.37–1.32). After accounting for non-compliance, the incidence of IMD remained significantly lower in the combined protection group (3.1 [95% CI: 1.5–4.8] vs. 0.5 [95% CI: 0.0–2.7], p=0.03), corresponding to a six-fold reduction in risk. Eleven infections were reported, predominantly due to serogroup B (45.5%). Ten patients recovered completely, one had mild residual disability. Conclusion Although guidelines recommend vaccination alone, our findings indicate that combined protection offers substantially greater protection against IMD in patients receiving long-term C5i. Continued prospective monitoring will be essential to define the optimal preventive strategies in this high-risk population.
Source: Kidney International Reports
Authors: Aleksandra Vujović, Franz Schaefer, Anne-Laure Sellier-Leclerc, Mattia Parolin, Víctor Pérez-Beltrán, Jonas Hofstetter, Olivia Boyer, Maria Cristina Mancuso, Sandra Habbig, Tanja Kersnik Levart, Klaus Arbeiter, Fabian Eibensteiner, Lovro Lamot, Justine Bacchetta, Lisa Condamine, Dounia Habchi, Lydia Slimani, Amina Talhi, Sacha Flammier, Marc Fila, Julie Tenenbaum, Laurence Heidet, Kahina Saidoun, Nabila Moussaoui, Stefan Kohl, Susanne Schaefer, Jose Antonio Ramirez Garcia, Marcus Weitz, Kathrin Buder, Lena Lechler, Matko Marlais, Orsolya Horváth, Giovanni Montini, Francesco Trepiccione, Miriam Zacchia, Germana Longo, Nicola Bertazza Partigiani, Antonio Gargiulo, Chiara Bettini, Vitor Hugo Martins, Aleksandra Zurowska, Magdalena Drozynska-Duklas, Anna Krakowska, Joaquim Calado, Rute Baeta Baptista, Ana Teixeira, Anca Marin, Valentin Mocanu, Andreja Aleš Rigler, Tomaž Šimnovec, Carla Soto, Romy Bouwmeester, Eiske Dorresteijn
Institutions: University of Ljubljana, Ljubljana University Medical Centre, Heidelberg University, Hospices Civils de Lyon, University of Padua, Azienda Ospedale - Università Padova, Vall d'Hebron Hospital Universitari, Hôpital Necker-Enfants Malades, Université Paris Cité, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Cologne, University Hospital Cologne
Language: English
Subfield: Microbiology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $2,800
Awards: G2872175397, G7799207878
OpenAlex ID: W4416661977