Gonorrhea: eculizumab tied to higher odds of disseminated infection

  • Crew PE & al.
  • Clin Infect Dis
  • 12 Nov 2018

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Due to its mechanism of action, eculizumab (Soliris) may increase the risk for life-threatening disseminated gonococcal infection (DGI).

Why this matters

  • Remain vigilant for meningococcal and DGI among patients receiving eculizumab.
  • Familiarity with/adherence to CDC guidelines for gonorrhea screening, patient education on heightened severe infection risk is essential.
  • Include DGI in differentials of patients on eculizumab presenting with gram-negative diplococcal infections (especially with skin, joint involvement).
  • Avoid macrolide prophylaxis if possible.

Key results

  • 9 FDA Adverse Event Reporting System pre-, postmarketing Neisseria gonorrhoeae (N gonorrhoeae) infection safety reports.
  • 89% (8/9) were classified as disseminated; all were hospitalized.
  • 87.5% (7/8) had positive blood culture, 1 with positive cervical culture, subsequent joint pain, and DGI diagnosis, leading to mortality.
  • 2 patients had septic shock, requiring vasopressors during acute period of illness.
  • 3/6 patients were on concomitant antibiotic prophylaxis; definitive antibiotics for N gonorrhoeae included: ceftriaxone (n=4), azithromycin (n=2), meropenem (n=1), and ciprofloxacin (n=1).

Study design

  • Case series describing N gonorrhoeae infection among patients receiving eculizumab, particularly among those progressing to DGI.
  • Funding: FDA, CDC.

Limitations

  • Database inconsistencies.
  • Reporting bias.
  • Small case numbers.
  • Majority of cases under age 25 years, increasing baseline risk regardless of eculizumab therapy.

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