
FDA Approves Complement C5 Inhibitor Zilucoplan for Myasthenia Gravis
With the approval, zilucoplan becomes the first once-daily subcutaneous complement C5 inhibitor available for adults with generalized myasthenia gravis.
This article was originally
The FDA has approved UCB Pharma’s investigational agent zilucoplan, a complement C5 inhibitor, to treat patients with
Data from the large-scale, double-blind, placebo-controlled, phase 3 RAISE study (
"For people with gMG, the unpredictable nature of the severity and frequency of symptoms can be debilitating and can have a substantial impact on many aspects of their day-to-day lives. In addition to muscle weakness, people living with gMG experience fatigue, affecting their overall quality of life,” lead investigator James F. Howard, MD, distinguished professor of neuromuscular disease and professor of neurology at The University of North Carolina at Chapel Hill School of Medicine,
Conducted from 2019 to 2021, 174 eligible patients were included and randomly assigned to either 0.3 mg/kg of zilucoplan (n = 86) or placebo (n = 88) for a 12-week period, followed by an optional open-label extension study (RAISE-XT;
In terms of safety, zilucoplan demonstrated a favorable profile, with treatment-emergent adverse events (TEAEs) occurring in 77% of patients. The most frequently reported TEAEs were injection-site bruising (16%), headache (15%), diarrhea (10%), and worsening of MG (10%). Between the 2 groups, the incidence of frequently reported TEAEs were similar, except for injection-site bruising, diarrhea, injection-site pain, and lipase increase, which were more frequent in the zilucoplan group.
In the zilucoplan group, 4 patients discontinued because of a TEAE (1 each of aphthous ulcer, mouth ulceration, hepatic enzyme increase, and COVID-19 leading to death) and 2 patients discontinued from the placebo group because of a TEAE (hyperemesis gravidarum and cerebral hemorrhage leading to death). Neither death was considered related to the study drug. Of note, a higher incidence of infections occurred in the zilucoplan group than in the placebo group (27% vs 18%), which was driven by nonserious upper respiratory tract infections (14% vs 7%). No meningococcal or other Neisseria spp infections or anaphylactic reactions occurred in either group.
“This is an important development for the community because, with more FDA-approved treatments for generalized myasthenia gravis, physicians have additional tools to treat this disease in individualized ways that are the right fit for each individual patient,” Samantha Masterson, president and CEO of the Myasthenia Gravis Foundation of America, said.1 “We are so grateful to UCB for being part of the myasthenia gravis community and their continued commitment to finding solutions for people living with this chronic, autoimmune, neuromuscular disease.”
Earlier this year,
Throughout the study, 4 treatment-emergent deaths occurred, all in patients with multiple
From double-blind study baseline, zilucoplan-treated individuals achieved LS mean changes in MG-ADL score of –6.30 (95% CI, –7.44 to –5.15). These results were similar for the placebo-switch group, with score reductions of –6.32 (95% CI, –8.00 to –4.65). Scores on key secondary outcomes such as QMG score, Myasthenia Gravis Composite score, and Myasthenia Gravis Quality of Life 15-item-revised, were similar across both treatment groups as well.
References
1. UCB announces US FDA approval of Zilbrysq (zilucoplan) for the treatment of adults with generalized myasthenia gravis. News release. UCB Pharma. October 17, 2023. Accessed October 17, 2023.
2. Howard JF, Bresch S, Genge A, et al. Safety and efficacy of zilucoplan in patients with generalized myasthia gravis (RAISE): a randomized, double-blind, placebo-controlled, phase 3 study. Lancet Neurol. 2023;22(5):395-406. doi:10.1016/S1474-4422(23)00080-7
3. Genge A, Hussain Y, Kaminski HJ, et al. Safety and tolerability of zilucoplan in RAISE-XT: a multicenter, open-label extension study in patients with myasthenia gravis. Presented at: MDA 2023; February 19-22; Dallas, Texas. Abstract 145.
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