{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:52:42Z","timestamp":1791204762368,"version":"4.2.0"},"reference-count":9,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["HemaSphere"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Paroxysmal nocturnal hemoglobinuria (PNH) is an ultra\u2010orphan disease. In 2026, approved complement inhibitors (CIs) for PNH include three C5 inhibitors (C5i) and three proximal inhibitors (PIs). Clinical trials for the approved PI pegcetacoplan, iptacopan, and C5i + danicopan had clear protocols for changing from terminal to PI, extrapolated into real\u2010world practice. There is no guidance for patients changing from a PI to a different CI. We present the largest international cohort to date. The inclusion criteria were as follows: patients established on a PI, who have changed treatment to a different CI. Sixty\u2010five patients with a median age at PNH diagnosis of 40 years were included. Indications for CI switch were as follows: hemolysis (extravascular\/recurrent breakthrough\/not specified), side effects, trial termination, patient choice, and other. CI changes (149) were classified as (1) terminal\u2010to\u2010proximal (75\/149), 6 hemolytic events reported within 14 days of CI change; (2) proximal\u2010to\u2010proximal (45\/149), 2 hemolytic events reported within 14 days of CI change; and (3) proximal\u2010to\u2010terminal (29\/149), 13 hemolytic events within 14 days of CI change. This is the largest cohort of PNH patients facing multiple CI changes. With the increasing availability of different CI classes, patients may experience several treatment changes over their disease course. CI should not be interrupted. The cohort would suggest that overlapping treatment for patients changing from PI to another CI is not required. Tapering of treatment does not seem to be effective at preventing hemolysis complications. Patients should be monitored closely for hemolysis, especially when changing from proximal\u2010to\u2010terminal inhibition. Prospective clinical\/laboratory analysis is recommended for further clarification management for this patient group.<\/jats:p>","DOI":"10.1002\/hem3.70427","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T14:36:56Z","timestamp":1784039816000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Switching between complement inhibitors in paroxysmal nocturnal hemoglobinuria: Analysis of strategy, efficacy, and safety"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4287-0595","authenticated-orcid":false,"given":"Morag","family":"Griffin","sequence":"first","affiliation":[{"name":"Haematology Department St James University Hospital Leeds United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0857-8379","authenticated-orcid":false,"given":"Bruno","family":"Fattizzo","sequence":"additional","affiliation":[{"name":"Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico Milan Italy"},{"name":"Department of Oncology and Hemato\u2010Oncology University of Milan Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong Wook","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Hematology Oncology Hanyang University Seoul Hospital Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Haematology Department St James University Hospital Leeds United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roochi","family":"Trikha","sequence":"additional","affiliation":[{"name":"Department of Haematology Kings College Hospital London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasutaka","family":"Ueda","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology The University of Osaka Graduate School of Medicine Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun\u2010ichi","family":"Nishimura","sequence":"additional","affiliation":[{"name":"Department of Hematology and Oncology The University of Osaka Graduate School of Medicine Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Patriquin","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology &amp; Haematology University Health Network Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"R\u00f6th","sequence":"additional","affiliation":[{"name":"Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen University Duisburg\u2010Essen Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra","family":"Muus","sequence":"additional","affiliation":[{"name":"Haematology Department St James University Hospital Leeds United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Panse","sequence":"additional","affiliation":[{"name":"Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation University Hospital RWTH Aachen Germany"},{"name":"Center for Integrated Oncology Aachen Bonn Cologne D\u00fcsseldorf (CIO ABCD) Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel G\u00f3mez","family":"\u00c1lvarez","sequence":"additional","affiliation":[{"name":"Facultativo especialista en Hematolog\u00eda y Hemoterapia Hospital Clinico San Carlos de Madrid Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Pike","sequence":"additional","affiliation":[{"name":"Haematology Department St James University Hospital Leeds United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Talha","family":"Munir","sequence":"additional","affiliation":[{"name":"Haematology Department St James University Hospital Leeds United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shreyans","family":"Gandhi","sequence":"additional","affiliation":[{"name":"Department of Haematology Kings College Hospital London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3180-3570","authenticated-orcid":false,"given":"Austin","family":"Kulasekararaj","sequence":"additional","affiliation":[{"name":"Department of Haematology Kings College Hospital London United Kingdom"},{"name":"Kings College University Kings College London London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199511093331904"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2023021762"},{"issue":"4","key":"e_1_2_12_4_1","first-page":"1","article-title":"Navigating the paroxysmal nocturnal hemoglobinuria (PNH) landscape","volume":"23","author":"Gerber GF","year":"2025","journal-title":"Clin Adv Hematol Oncol"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2019.01157"},{"key":"e_1_2_12_6_1","article-title":"Efficacy and safety of vemircopan as monotherapy in patients with paroxysmal nocturnal hemoglobinuria","author":"Kulasekararaj AG","year":"2025","journal-title":"Blood Adv"},{"key":"e_1_2_12_7_1","unstructured":"BioCryst Pharmaceuticals.BCX9930 for the treatment of paroxysmal nocturnal hemoglobinuria (PNH) in participants with inadequate response to C5 inhibitor therapy (REDEEM\u20101). ClinicalTrials.gov. NCT05116774. Updated March 7 2025. Accessed January 16 2026.https:\/\/clinicaltrials.gov\/study\/NCT05116774"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2022019576"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.27502"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2029073"}],"container-title":["HemaSphere"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hem3.70427","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hem3.70427","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hem3.70427","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:09:44Z","timestamp":1791202184000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hem3.70427"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":9,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1002\/hem3.70427"],"URL":"https:\/\/doi.org\/10.1002\/hem3.70427","archive":["Portico"],"relation":{},"ISSN":["2572-9241","2572-9241"],"issn-type":[{"value":"2572-9241","type":"print"},{"value":"2572-9241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2026-03-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70427"}}