Clin Nephrol. 2021 Jul;96(1):51-59. doi: 10.5414/CN110443.
Bevacizumab is a recombinant monoclonal antibody against the vascular endothelial growth factor A (VEGF-A) ligand that is used in the management of various solid malignancies. The adverse effect profiles of angiogenesis inhibitors, such as bevacizumab, have become increasingly well characterized and include renal manifestations such as hypertension, proteinuria, and thrombotic microangiopathy. Eculizumab inhibits terminal-complement activation and is used to treat atypical hemolytic uremic syndrome. There has been growing usage of eculizumab to treat bevacizumab-associated thrombotic microangiopathy.
We performed a systematic review of the literature to identify full-text articles that describe the use of eculizumab for bevacizumab-associated thrombotic microangiopathy.
Our systematic review identified 522 unique articles of which 5 were included in the final review. 9 cases, including 2 new cases presented in this review, were identified in which eculizumab was used in the management of bevacizumab-associated thrombotic microangiopathy. Hematologic parameters and kidney function stabilized or improved in all cases, and the 2 patients who required renal replacement therapy were able to discontinue dialysis.
Given the findings of this systematic review, the use of eculizumab in the treatment of bevacizumab-associated thrombotic microangiopathy warrants further study, particularly in severe cases.
贝伐珠单抗是一种针对血管内皮生长因子 A（VEGF-A）配体的重组单克隆抗体，用于治疗各种实体恶性肿瘤。血管生成抑制剂（如贝伐珠单抗）的不良反应谱已得到越来越充分的描述，包括高血压、蛋白尿和血栓性微血管病等肾脏表现。依库珠单抗抑制末端补体激活，用于治疗非典型溶血尿毒综合征。依库珠单抗越来越多地用于治疗贝伐珠单抗相关的血栓性微血管病。
我们对文献进行了系统回顾，以确定描述依库珠单抗治疗贝伐珠单抗相关血栓性微血管病的全文文章。
我们的系统综述共确定了 522 篇独特的文章，其中 5 篇被纳入最终综述。在这 5 篇文章中，有 9 例（包括本综述中介绍的 2 例新病例）患者使用依库珠单抗治疗贝伐珠单抗相关血栓性微血管病。所有病例的血液学参数和肾功能稳定或改善，需要肾脏替代治疗的 2 例患者能够停止透析。
鉴于这项系统综述的结果，依库珠单抗治疗贝伐珠单抗相关血栓性微血管病的应用值得进一步研究，特别是在严重病例中。
