Neurológia pre prax 1/2026
Vaccination in patients receiving complement inhibitor therapy – guidelines for clinical practice
The complement system is a part of the innate, non-specific immunity and performs numerous functions in the organism. Among other things, it plays a pivotal role in host defence against Neisseria spp., but is also essential for protection against a wide spectrum of other pathogens. Excessive complement activation is implicated in several immune-mediated diseases, which has led to the development of selective complement inhibitors (CIs) with expanding therapeutic potential. Currently, for clinical use, we have terminal complement inhibitors targeting component C5 (eculizumab and its biosimilar, ravulizumab, zilucoplan) and a proximal complement inhibitor targeting component C3 (pegcetacoplan). In the near future, several other molecules will enter clinical use. CIs are primarily used to treat complement-mediated haematological and neurological diseases. Practically immediately after starting treatment, the risk of infections caused by encapsulated microorganisms, especially Neisseria spp., significantly increases. The cornerstone of infection prevention when using complement inhibitors is vaccination with or without antibiotic prophylaxis. For individual CI preparations, there are certain differences in mandatory vaccinations according to the respective SPC. Vaccination against all serogroups of meningococci is universally indicated (a combination of a 4-valent conjugate vaccine against A, C, W, Y and a vaccine against serogroup B). Furthermore, for some CIs, vaccination against pneumococci and Haemophilus influenzae type b is also required. Influenza vaccination is also recommended. It is advisable to complete the entire primary vaccination schedule at least 2 weeks before initiating CI treatment. If the patient’s condition or administered treatment does not allow this, or if the entire vaccination schedule is not completed, antibiotic prophylaxis is essential, for at least 14 days after the completion of the entire primary vaccination schedule.
Keywords: antibiotic prophylaxis, complement inhibitors, complement system, meningococci, vaccination
