Clinical course after eculizumab cessation. (A) Patients that discontinued eculizumab on the physician-directed protocol. (B) Patients that discontinued or interrupted therapy due to nonadherence. (C) Patients that did not discontinue complement inhibition therapy. Origin of the x-axis is at initiation of eculizumab therapy for acute thrombotic microangiopathy. Duration of eculizumab therapy is indicated in blue, relapse is indicated in red, and relapse-free time off eculizumab therapy is indicated in green. Patient 23 (A) was briefly restarted on eculizumab in the setting of renal transplant. Patient 32 has switched to ravulizumab, and patients 51 and 55 are in the process of switching. D, death during follow-up.