Active Ingredient: Eculizumab
Eculizumab is indicated in adults for the treatment of refractory generalized myasthenia gravis (gMG) in patients aged 6 years and above who are anti-acetylcholine receptor (AChR) antibody-positive.
For this indication, competent medicine agencies globally authorize below treatments:
For:
Intravenous, 900 milligrams eculizumab, once weekly, over the duration of 4 weeks. Afterwards, intravenous, 1,200 milligrams eculizumab, one dose, over the duration of 1 week. Afterwards, intravenous, 1,200 milligrams eculizumab, once every 14 to 16 days.
The refractory gMG dosing regimen for adult patients (≥18 years of age) consists of a 4 week initial phase followed by a maintenance phase:
Available data suggest that clinical response is usually achieved by 12 weeks of eculizumab treatment. Discontinuation of the therapy should be considered in a patient who shows no evidence of therapeutic benefit by 12 weeks.
Eculizumab treatment is recommended to continue for the patient’s lifetime, unless the discontinuation of eculizumab is clinically indicated.
Eculizumab may be administered to patients aged 65 years and over. There is no evidence to suggest that any special precautions are needed when older people are treated–although experience with eculizumab in this patient population is still limited.
The diluted solution of eculizumab should be administered by intravenous infusion over 25–45 minutes (35 minutes ± 10 minutes) in adults.
Patients should be monitored for one hour following infusion. If an adverse event occurs during the administration of eculizumab, the infusion may be slowed or stopped at the discretion of the physician. If the infusion is slowed, the total infusion time may not exceed two hours in adults and four hours in paediatric patients under 18 years of age.
There is limited safety data supporting home-based infusions, additional precautions in the home setting such as availability of emergency treatment of infusion reactions or anaphylaxis are recommended.
For:
Regimen A: In case that patient age in years is ≥ 6 and patient weight is ≥ 30 kg and patient weight is < 40 kg, intravenous, 600 milligrams eculizumab, once weekly, over the duration of 2 weeks. Afterwards, in case that patient age in years is ≥ 6 and patient weight is ≥ 30 kg and patient weight is < 40 kg, intravenous, 900 milligrams eculizumab, one dose, over the duration of 1 week. Afterwards, in case that patient age in years is ≥ 6 and patient weight is ≥ 30 kg and patient weight is < 40 kg, intravenous, 900 milligrams eculizumab, once every 2 weeks.
Regimen B: In case that patient age in years is ≥ 6 and patient weight is ≥ 20 kg and patient weight is < 30 kg, intravenous, 600 milligrams eculizumab, once weekly, over the duration of 2 weeks. Afterwards, in case that patient age in years is ≥ 6 and patient weight is ≥ 20 kg and patient weight is < 30 kg, intravenous, 600 milligrams eculizumab, one dose, over the duration of 1 week. Afterwards, in case that patient age in years is ≥ 6 and patient weight is ≥ 20 kg and patient weight is < 30 kg, intravenous, 600 milligrams eculizumab, once every 2 weeks.
Regimen C: In case that patient age in years is ≥ 6 and patient weight is ≥ 10 kg and patient weight is < 20 kg, intravenous, 600 milligrams eculizumab, one dose, over the duration of 1 week. Afterwards, in case that patient age in years is ≥ 6 and patient weight is ≥ 10 kg and patient weight is < 20 kg, intravenous, 300 milligrams eculizumab, one dose, over the duration of 1 week. Afterwards, in case that patient age in years is ≥ 6 and patient weight is ≥ 10 kg and patient weight is < 20 kg, intravenous, 300 milligrams eculizumab, once every 2 weeks.
Regimen D: In case that patient age in years is ≥ 6 and patient weight is ≥ 5 kg and patient weight is < 10 kg, intravenous, 300 milligrams eculizumab, one dose, over the duration of 1 week. Afterwards, in case that patient age in years is ≥ 6 and patient weight is ≥ 5 kg and patient weight is < 10 kg, intravenous, 300 milligrams eculizumab, one dose, over the duration of 1 week. Afterwards, in case that patient age in years is ≥ 6 and patient weight is ≥ 5 kg and patient weight is < 10 kg, intravenous, 300 milligrams eculizumab, once every 3 weeks.
In paediatric refractory gMG patients with body weight below 40 kg, the eculizumab dosing regimen consists of:
| Patient Body Weight | Initial Phase | Maintenance Phase |
|---|---|---|
| 30 to <40 kg | 600 mg weekly for the first 2 weeks | 900 mg at week 3; then 900 mg every 2 weeks |
| 20 to <30 kg | 600 mg weekly for the first 2 weeks | 600 mg at week 3; then 600 mg every 2 weeks |
| 10 to <20 kg | 600 mg single dose at week 1 | 300 mg at week 2; then 300 mg every 2 weeks |
| 5 to <10 kg | 300 mg single dose at week 1 | 300 mg at week 2; then 300 mg every 3 weeks |
Eculizumab treatment is recommended to continue for the patient’s lifetime, unless the discontinuation of Soliris is clinically indicated.
The diluted solution of eculizumab should be administered by intravenous infusion over 25–45 minutes (35 minutes ± 10 minutes) in adults.
Patients should be monitored for one hour following infusion. If an adverse event occurs during the administration of eculizumab, the infusion may be slowed or stopped at the discretion of the physician. If the infusion is slowed, the total infusion time may not exceed two hours in adults and four hours in paediatric patients under 18 years of age.
There is limited safety data supporting home-based infusions, additional precautions in the home setting such as availability of emergency treatment of infusion reactions or anaphylaxis are recommended.
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