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FDA approved Soliris (eculizumab) for Generalized Myasthenia Gravis and NMOSDFDA approved Soliris for two rare autoimmune diseases.

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Key Takeaway
Consider Soliris for anti-AChR-positive gMG and anti-AQP4-positive NMOSD; ensure meningococcal vaccination before starting.

The FDA has approved Soliris (eculizumab) for two new indications: generalized myasthenia gravis (gMG) in adult and pediatric patients six years of age and older who are anti-acetylcholine receptor (AChR) antibody positive, and neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive. Soliris, a complement inhibitor, was previously approved for paroxysmal nocturnal hemoglobinuria (PNH) and atypical hemolytic uremic syndrome (aHUS). The approval expands treatment options for these rare autoimmune disorders. Clinicians should note that Soliris carries a boxed warning for serious meningococcal infections, and patients must be vaccinated prior to initiation. The drug is administered intravenously with specific dosing regimens for each indication.

Clinical Details (Mechanism · Dosing · Trial Data · Warnings)
Mechanism of Action

Soliris (eculizumab) is a complement inhibitor. It binds to complement protein C5, inhibiting its cleavage to C5a and C5b, thereby preventing the formation of the membrane attack complex (MAC). This reduces complement-mediated cell destruction and thrombotic microangiopathy.

Indication & Patient Population

Soliris is indicated for: - Paroxysmal nocturnal hemoglobinuria (PNH) to reduce hemolysis. - Atypical hemolytic uremic syndrome (aHUS) to inhibit complement-mediated thrombotic microangiopathy. Limitation of use: Not indicated for Shiga toxin E. coli related hemolytic uremic syndrome (STEC-HUS). - Generalized myasthenia gravis (gMG) in adult and pediatric patients six years of age and older who are anti-acetylcholine receptor (AChR) antibody positive. - Neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive.

Dosing & Administration

For intravenous infusion only. - PNH (adults 18+): 600 mg weekly for 4 weeks, then 900 mg at week 5, then 900 mg every 2 weeks. - aHUS, gMG, NMOSD (adults 18+): 900 mg weekly for 4 weeks, then 1200 mg at week 5, then 1200 mg every 2 weeks. - Pediatric aHUS (<18 years) and gMG (6 years and older): Weight-based dosing (see Table 1 in label). - Supplemental dosing required after plasmapheresis/plasma exchange or fresh frozen plasma infusion (aHUS, gMG, NMOSD) and with IVIg (gMG). - Vaccinate against meningococcal infection at least 2 weeks prior to initiation; if urgent, provide antibacterial prophylaxis and vaccinate as soon as possible. - Prescribers must enroll in the ULTOMIRIS and SOLIRIS REMS.

Key Clinical Trial Data

Trial data not available in label.

Warnings & Contraindications

- Boxed warning: Serious meningococcal infections. Vaccinate patients against meningococcal serogroups A, C, W, Y and B at least 2 weeks prior to initiation. If urgent therapy needed, provide antibacterial prophylaxis and vaccinate as soon as possible. - Enrollment in REMS required. - Administer at recommended time points or within two days.

Place in Therapy

Soliris is a targeted complement inhibitor for rare, complement-mediated disorders. It is indicated for PNH, aHUS, anti-AChR antibody-positive gMG, and anti-AQP4 antibody-positive NMOSD. It is not indicated for STEC-HUS. Use requires meningococcal vaccination and REMS enrollment.

The FDA has approved Soliris (eculizumab) for two new uses: generalized myasthenia gravis (gMG) in adults and children ages 6 and older who have a specific antibody, and neuromyelitis optica spectrum disorder (NMOSD) in adults with a different antibody. Soliris is a complement inhibitor, meaning it blocks part of the immune system that can cause damage. It was already approved for two other rare blood and kidney disorders.

This approval is for patients with gMG who test positive for anti-AChR antibodies, and for NMOSD patients who test positive for anti-AQP4 antibodies. These are serious autoimmune diseases that can cause muscle weakness, vision loss, and other problems. The drug is given through an IV, with different dosing schedules for each condition.

For patients, this means there is now an approved treatment for these specific forms of these diseases. However, Soliris has a boxed warning about a serious risk of meningococcal infection. Patients must be vaccinated before starting treatment. This approval does not mean the drug is right for everyone. It is important to talk to your doctor about whether Soliris is a good option for you, based on your medical history and test results.

What this means for you:
Soliris is now approved for certain patients with gMG and NMOSD, but requires vaccination and a doctor's guidance.

Study Details

Study typeFda approval
PublishedMar 2007
View Original Abstract ↓
1 INDICATIONS AND USAGE SOLIRIS is a complement inhibitor indicated for: the treatment of patients with paroxysmal nocturnal hemoglobinuria (PNH) to reduce hemolysis. ( 1.1 ) the treatment of patients with atypical hemolytic uremic syndrome (aHUS) to inhibit complement-mediated thrombotic microangiopathy. ( 1.2 ) Limitation of Use SOLIRIS is not indicated for the treatment of patients with Shiga toxin E. coli related hemolytic uremic syndrome (STEC-HUS). the treatment of generalized myasthenia gravis (gMG) in adult and pediatric patients six years of age and older who are anti-acetylcholine receptor (AChR) antibody positive. ( 1.3 ) the treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive. ( 1.4 ) 1.1 Paroxysmal Nocturnal Hemoglobinuria (PNH) SOLIRIS is indicated for the treatment of patients with paroxysmal nocturnal hemoglobinuria (PNH) to reduce hemolysis. 1.2 Atypical Hemolytic Uremic Syndrome (aHUS) SOLIRIS is indicated for the treatment of patients with atypical hemolytic uremic syndrome (aHUS) to inhibit complement-mediated thrombotic microangiopathy. Limitation of Use SOLIRIS is not indicated for the treatment of patients with Shiga toxin E. coli related hemolytic uremic syndrome (STEC-HUS). 1.3 Generalized Myasthenia Gravis (gMG) SOLIRIS is indicated for the treatment of generalized myasthenia gravis (gMG) in adult and pediatric patients six years of age and older who are anti-acetylcholine receptor (AChR) antibody positive. 1.4 Neuromyelitis Optica Spectrum Disorder (NMOSD) SOLIRIS is indicated for the treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive.
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