Eculizumab

What is eculizumab?

Eculizumab is a medication that suppresses the immune system. Sometimes, it is prescribed for individuals with autoimmune myasthenia gravis (MG). It is manufactured as a solution for intravenous infusion under the brand name Soliris®. 

Why am I being treated with eculizumab?

Eculizumab is prescribed for some individuals with refractory, generalized MG associated with acetylcholine receptor antibodies (AChR). Refractory refers to people who have significant MG symptoms despite aggressive treatment with other medications that suppress the immune system. 

How does eculizumab work?

Eculizumab blocks one mechanism used by the immune system to destroy foreign invaders such as bacteria and viruses. In autoimmune MG, this portion of the immune system also damages the muscle endplate region and causes weakness. 

How soon should I see a response?

Individuals who respond to eculizumab often see improvement in the first one to two months. However, it may take up to 12 weeks for some people with MG to see improvement. Unless another MG treatment is used, or your MG goes into remission, the eculizumab infusions must be continued indefinitely to sustain the improvement. 

How is eculizumab given? 

Eculizumab is given as a series of intravenous infusions. The first five doses are given weekly, and subsequent doses are given every two weeks. In adults, the infusions are performed in a little more than ½ hour. 

What are the risks associated with eculizumab?

Eculizumab lowers the ability of the immune system to fight certain infections, especially meningococcal infections that cause life-threatening sepsis and meningitis. Patients must therefore be vaccinated against the meningococcus bacteria a minimum of two weeks before starting eculizumab. They must also receive periodic booster vaccinations to maximize their immunity to meningococcus and similar bacteria. The available meningococcal vaccines help protect against infections involving many, but not all types of meningococcal bacteria. It is important to realize that vaccinations reduce but do not eliminate the possibility of meningococcal infection, especially in patients taking other immunosuppressive medications. 

When should I seek medical care for possible meningococcal infection? 

Call your doctor or seek emergency medical care immediately for signs and symptoms of a meningococcal infection including:

• Headache with nausea or vomiting
• Headache and a fever
• Headache with a stiff neck or stiff back 
• Fever
• Fever and a rash
• Confusion
• Muscle aches with flu-like symptoms
• Eyes sensitive to light

What are other concerns associated with eculizumab?

Eculizumab is expensive, which can present a major issue in accessing the treatment. It is important to discuss the cost of this medication with your health insurance provider and infusion provider to prevent financial difficulties. 

Because of the risks related to eculizumab, prescribing physicians must be enrolled in the Soliris® Risk Evaluation and Mitigation Strategy (REMS) program in order to educate patients about the risk of meningococcal infection and to ensure that patients are properly vaccinated.