Comparison between effectiveness and safety of plasma therapy and complement inhibitors for the treatment of atypical hemolytic uremic syndrome: a systematic review and meta-analysis of real-world data.
Thy Phuong Anh Le, Juliana Tze-Wah Kao, Mei-Yi Wu et al.
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In 30 seconds
This systematic review and meta-analysis compared plasma therapy (PT) with complement inhibitors (CIs) for atypical hemolytic uremic syndrome using 106 observational cohort studies. Overall, the treatments did not differ significantly in effectiveness or safety, except that relapse was less frequent with CIs than PT (0% vs. 15.5%, p < 0.001). In children, CI therapy was associated with lower rates of chronic kidney disease, relapse, and mortality than PT. Among adults, no significant differences were found in initial response, prognosis, or safety.
Key findings
- Across studies, relapse was lower with CIs than PT (0% vs. 15.5%, p < 0.001); other overall effectiveness and safety outcomes did not differ significantly.
- In children, CIs were associated with lower CKD (24.6% vs. 56.6%, p < 0.001), relapse (6.2% vs. 25.5%, p = 0.02), and mortality (0.3% vs. 7.6%, p = 0.002) than PT.
- In adults, PT and CIs showed no significant differences in initial treatment response, prognosis, or safety.
- For patients with positive anti-complement factor H antibodies, renal remission was higher with CIs than PT (90% vs. 41.8%, p = 0.02).
Why it matters
The findings suggest that treatment comparisons may differ by age and clinical subgroup, rather than supporting a single overall advantage for either strategy. The pediatric outcome differences and lower pooled relapse rate with CIs may inform interpretation of real-world evidence, while the observational basis means these associations should not be treated as proof that one therapy causes better outcomes.
What to keep in mind
The evidence came from observational cohort studies, so treatment comparisons may be affected by differences between patient groups and study settings.