{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T07:02:26Z","timestamp":1779951746805,"version":"3.53.1"},"reference-count":115,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:p>Atypical hemolytic uremic syndrome (aHUS) represents an uncommon, life-threatening complement-mediated thrombotic microangiopathy that is linked to both significant renal and extrarenal complications. Eculizumab, a monoclonal antibody targeting complement component C5, has dramatically improved patient outcomes and is widely recognized as a first-line therapy. However, uncertainty remains regarding the optimal dosing regimen, therapeutic monitoring, feasibility of treatment discontinuation, and appropriate duration of therapy in patients with aHUS. This narrative review is based on a PubMed literature search conducted through 2025, with search terms encompassing aHUS, eculizumab, complement inhibitor, treatment discontinuation, and dosing strategies. By integrating evidence from key clinical trials, observational cohorts, and registry-based analyses, a comprehensive evaluation of eculizumab\u2019s efficacy and safety profiles is presented. We discuss individualized management strategies, with particular emphasis on dose optimization. Importantly, we focus on the available evidence regarding eculizumab discontinuation, addressing its feasibility, relapse risk, and post-discontinuation monitoring strategies, and suggest that cautious treatment withdrawal can be considered in selected patients under close surveillance. In addition, tailored management approaches for specific aHUS subtypes are discussed. In conclusion, we outline future directions for complement C5 inhibition, emphasizing that the advancement and clinical implementation of novel C5 inhibitors may offer new opportunities for the long-term management of aHUS.<\/jats:p>","DOI":"10.3389\/fphar.2026.1834141","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T06:15:42Z","timestamp":1779948942000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Therapeutic advances in eculizumab for atypical hemolytic uremic syndrome: a narrative review"],"prefix":"10.3389","volume":"17","author":[{"given":"Dandan","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Nephrology, Shenzhen People\u2019s Hospital, The Second Clinical Medical College, Jinan University","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yichen","family":"Xiao","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The First Affiliated Hospital, School of Medicine, Southern University of Science and Technology","place":["Shenzhen, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hualin","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Shenzhen People\u2019s Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology)","place":["Shenzhen, Guangdong, China"]},{"name":"Shenzhen Key Laboratory of Kidney Diseases","place":["Shenzhen, Guangdong, China"]},{"name":"Shenzhen Clinical Research Center for Geriatrics, Shenzhen People\u2019s Hospital","place":["Shenzhen, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1007\/s40620-023-01831-5","article-title":"Severe proteinuria (but not being on dialysis) may be associated with initial inadequate complement inhibition and delayed hematological response to eculizumab therapy","volume":"37","author":"Allinovi","year":"2024","journal-title":"J. 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