Treatment of Paroxysmal Nocturnal Hemoglobinuria in Pregnancy
Clinical Scenario
Patients with paroxysmal nocturnal hemoglobinuria (PNH) who are pregnant represent a distinct management challenge. Pregnancy alters the clinical course and introduces important considerations around the selection and continuation of therapy.
Pregnancy & PNH
The presence of pregnancy requires careful evaluation of which therapeutic agents are appropriate. Treatment with certain complement inhibitors should be avoided in patients who are pregnant or planning pregnancy, given the available safety data.
Treatment Approach (Overview)
Management centres on complement inhibitor therapy, with specific guidance on which agents are appropriate to continue or initiate during pregnancy. The approach includes considerations around dosing adjustments if needed —
The full evidence-based regimen, agent selection criteria, and monitoring guidance are available in the structured protocol …
References
- Ongoing treatment with eculizumab should not be interrupted if a pregnancy is diagnosed.
- A dose adjustment (up to 900 mg weekly) may be necessary due to breakthrough hemolysis during pregnancy.
- In contrast to eculizumab, there is insufficient data on the use of ravulizumab and all other newly approved complement inhibitors in pregnancy.
- Treatment with these substances should therefore be avoided for the time being if the patient is pregnant or already planning genetic counseling.