Journal Article

DZNE-2026-00816

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Expertenkonsensus: Meningokokkenprophylaxe in der Therapie neurologischer Erkrankungen mit Komplementinhibitoren | Meningococcal prophylaxis in neurological diseases treated with complement inhibitors: an expert consensus

Berthele, A. ; Aktas, O. ; Ayzenberg, I. ; Claus, H. ; Lâm, T.-T. ; Löscher, W. N. ; Lünemann, J. D. ; Pröbstel, A.-K.Extern* ; Prüß, H.DZNE* ; Rademacher, N. ; Ringelstein, M. ; Rommer, P. S. ; Schara-Schmidt, U. ; Schoser, B. ; Weber, J. R. ; Zschüntzsch, J. ; Meisel, A.

2025
Springer Medizin Verlag GmbH, ein Teil von Springer Nature Heidelberg

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Please use a persistent id in citations: doi:10.1007/s42451-025-00774-4

Abstract: While inhibition of terminal complement activation is an effective therapeutic strategy in acetylcholine receptor antibody-positive generalized myasthenia gravis (AChR-Ab+ gMG) and aquaporin‑4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-Ab+ NMOSD), it is associated with an increased risk for invasive meningococcal infection. As such, all patients receiving complement inhibitors—including eculizumab, ravulizumab, and zilucoplan—require vaccination against meningococcal serogroups A, C, W, Y (MenACWY) and B (MenB). An expert panel evaluated the available data and has provided recommendations for preventive strategies to reduce the risk of invasive meningococcal infection during complement inhibitor therapy in Germany, Austria and Switzerland (the DACH region). Three strategies are available for coordinating vaccination and the initiation of complement inhibitor therapy: (1) administer vaccination at least 2 weeks before starting therapy; (2) start therapy concurrently with vaccination, accompanied by antibiotic prophylaxis until an immune response develops; (3) start therapy first and delay vaccination, continuing antibiotic prophylaxis until 14 days after the vaccine is administered. In the case of NMOSD, treatment must often begin urgently, particularly following a relapse. In such cases, vaccination should be administered concurrently with the initiation of or transition to complement inhibition, accompanied by antibiotic prophylaxis. In contrast, treatment urgency is generally lower in gMG, allowing vaccination to be completed beforehand and thus avoiding the need for antibiotics, which may exacerbate gMG symptoms. The expert group recommends ceftriaxone as the first-line treatment for active infection, rifampicin for prophylaxis, and either rifampicin or intramuscular ceftriaxone for post-exposure chemoprophylaxis. The expert group recommends that patients carry standby ciprofloxacin for emergency use, to be taken at the first sign of illness, followed by prompt clinical assessment.

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Contributing Institute(s):

1. Autoimmune Encephalopathies (AG Prüß)

Research Program(s):

1. 353 - Clinical and Health Care Research (POF4-353) (POF4-353)

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Database coverage:
DEAL Springer ; DEAL Springer

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