Improvement in anemia and symptoms after switching from crovalimab to iptacopan in paroxysmal nocturnal hemoglobinuria.
Daisuke Ogiya, Sawako Shiraiwa, Seina Koyama et al.
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Case in brief
A 72-year-old man with long-standing paroxysmal nocturnal hemoglobinuria developed breakthrough hemolysis and worsening anemia during crovalimab therapy after infectious enteritis. Although the infection resolved, anemia persisted, prompting a switch to iptacopan 200 mg twice daily, started three weeks after his last crovalimab dose. Hemoglobin rose from 9.6 to 11.6 g/dL within two weeks and remained at least 12 g/dL thereafter. Dyspnea resolved within one week and vitality improved by two weeks. No further breakthrough hemolysis or treatment-related adverse events were reported during 12 months of follow-up.
What made this case unusual
The report describes a real-world switch from crovalimab to iptacopan, with timing guided by pharmacokinetic considerations despite no established switching method.
Diagnostic / clinical pearl
Persistent anemia after an episode of breakthrough hemolysis on C5 inhibition may prompt consideration of proximal complement inhibition; this case illustrates improvement after switching to iptacopan.