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Antimeningococcal Protection in Patients Receiving Terminal Complement Inhibitors
Aleksandra Vujović1,2, Franz Schaefer3, Anne-Laure Sellier-Leclerc4
1Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Kidney International Reports
|January 19, 2026
Summary
Complement inhibitor therapy increases invasive meningococcal disease (IMD) risk. Combined vaccination and antibiotic prophylaxis significantly reduced IMD incidence by 6-fold in C5 inhibitor patients, offering superior protection.
Area of Science:
- Immunology
- Infectious Diseases
- Pharmacology
Background:
- C5 inhibitor (C5i) therapy blocks the terminal complement pathway, increasing susceptibility to invasive meningococcal disease (IMD).
- Current recommendations emphasize vaccination, but breakthrough infections occur, and antibiotic prophylaxis practices vary.
- This study evaluates the added benefit of antibiotic prophylaxis in C5i-treated patients already receiving vaccination.
Purpose of the Study:
- To assess the additional protection conferred by antibiotic prophylaxis beyond vaccination in patients undergoing long-term C5 inhibitor therapy.
- To determine the incidence of IMD in C5i recipients under different preventive strategies.
- To analyze the impact of adherence on the effectiveness of combined protection.
Main Methods:
- Analysis of 124 patients receiving C5i therapy for over 6 months.
- Classification into single protection (vaccination or antibiotics alone) and combined protection (vaccination and continuous antibiotics).
- Outcomes assessed by prescribed and implemented regimens, accounting for adherence to antibiotic prophylaxis.
Main Results:
- Combined protection was prescribed for 60% of patients; however, booster vaccination coverage was low (<40%) and adherence to antibiotics was suboptimal (25% non-adherence).
- The overall IMD incidence was 0.74 cases per 100 patient-years.
- After adjusting for noncompliance, combined protection demonstrated a 6-fold reduction in IMD risk (incidence 0.5 vs. 3.1 per 100 PY; P=0.03), with most infections caused by serogroup B.
Conclusions:
- Combined vaccination and antibiotic prophylaxis provide significantly greater protection against IMD in C5i-treated patients than vaccination alone.
- Current guidelines recommending vaccination solely may not be sufficient for this high-risk population.
- Further prospective monitoring is crucial to establish optimal preventive strategies for long-term C5i therapy recipients.
Keywords:
antibiotic prophylaxisantimeningococcal protectionantimeningococcal vaccinationatypical hemolytic uremic syndromecomplement inhibitorsmeningococcal infectionMore Related Videos
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