A systematic review of short-term outcomes in patients with anti-factor H associated atypical HUS managed with plasma exchanges versus eculizumab.
Aditi Sinha, Tanvi Bindal, Federica Zotta et al.
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In 30 seconds
This systematic review compared short-term outcomes in patients with anti-factor H antibody-associated atypical haemolytic uraemic syndrome affecting native kidneys, treated with plasma exchange (PEX) or eculizumab (ECZ), with or without immunosuppression. Fourteen studies contributed individual data for 99 patients: 81 received PEX and 18 ECZ. Median time to haematological remission was shorter with PEX (9 vs. 20 days; P = 0.0007), while time to renal recovery was similar (16 vs. 20 days; P = 0.36). The groups differed in baseline severity, and the review found no controlled comparative studies.
Key findings
- Median time to haematological remission was 9 days with PEX versus 20 days with ECZ (P = 0.0007).
- Median time to renal recovery was 16 days with PEX versus 20 days with ECZ (P = 0.36).
- Patients receiving PEX presented with more severe disease and more often required dialysis.
- CKD G3-5 and mortality were insignificantly more frequent with PEX than ECZ (respective P 0.077 and 0.36).
Why it matters
The findings suggest that haematological remission may occur sooner with PEX, without an observed difference in time to renal recovery. This comparison is relevant because anti-factor H-associated disease may be managed with either PEX-based therapy or complement blockade, but the evidence remains observational and groups differed in disease severity. The results help frame uncertainty rather than establish comparative treatment efficacy.
What to keep in mind
The review included few studies and participants, no controlled comparisons, heterogeneous disease severity, and varying outcome definitions.