Article No. 311
21 January 2020
Information about Ravulizumab cwvz has featured regularly on the alliance website during its development to become the next generation eculizumab. In this short series a spotlight will be shone on a number of basic facts about the use of Ravulizumab.
Ravulizumab ( trade name Ultomiris) is indicated for :
– adults with PNH
– adults and children(1 month or older) with aHUS
to inhibit complement mediated thrombotic microagiopathy TMA.
It is not indicated for Shiga toxin e. Coli HUS.
It is supplied in a single dose vial with a strength of 300mg/30mL ( 10mg/mL).
There is a weight based dosing regimen for the number of vials needed for loading ( starting treatment for first time or transitioning from eculizumab) and maintenance ( longer term treatment) levels of Ravulizumab .
The following table shows the dose volumes for both loading and maintenance regimens according to weight.
| Body weight Steps (kg) | Loading dose (mg) | Maintenance dose (mg) | Infusion interval ( weeks) |
| = 5-10 | 600 | 300 | 4 |
| >10-20 | 600 | 600 | 4 |
| >20-30 | 900 | 2100 | 8 |
| >30-40 | 1200 | 2700 | 8 |
| >40-60 | 2400 | 3000 | 8 |
| > 60-100 | 2700 | 3300 | 8 |
| > 100 | 3000 | 3600 | 8 |
Maintenance dosing begins 2 weeks after the loading dose has been administered. For the transition from eculizumab , the loading dose commences 2 weeks after last the eculizumab dose followed by maintenance dosing beginning two weeks later.
For children on the two lowest weight steps the infusion interval is four weeks.
Dosing is prepared by extracting the drug from the prescribed number of vials and diluting it in a solution bag contain 0.9% sodium cloride. Solution bags should not be used if sign of “particulate matter” , discolouration or “precipitation.
There is a prescribed infusion rate according to dose volume. A minimum time to complete maintenance infusion is shown in the following table:
| Body Weight step (kg) | Maintenance dose volume (mg) | Volume (mL) inc. diluent) | Flow rate maximum (mLper hour) |
Infusion time ( minImum) Hours |
Infusion time for eculizumab per 4/8 week period |
| =5- 10 | 300* | 60 | 31 | 1.9 | 2-8* |
| >10-20 | 600* | 120 | 63 | 1.9 | 2-8* |
| >20-30 | 2100 | 420 | 127 | 3.3 | 4-16* |
| >30-40 | 2700 | 540 | 192 | 2.8 | 4-16* |
| >40-60 | 3000 | 600 | 257 | 2.3 | 2.3** |
| >60-100 | 3300 | 660 | 330 | 2 | 2.3** |
| >100 | 3600 | 720 | 327 | 2.2 | 2.3** |
* child infusion time 1-4 hours ** adult infusion time 35 minutes
Generally the minimum time for an infusion excluding preparation and monitoring is about two hours but for older children it will take around 3 hours. Infusion flow rate can be slowed down if there is a reaction in patient . The monitoring time for any reaction is 1 hour post infusion, so in a 4/8 period further time is saved. There will also be less infusion preparation time and visting/traveling time to clinic due to fewer infusions.
As well as comparably less treatment time than for eculizumab over 8 week periods , the volume of Ravulizumab administered in an 8 week period is significantly less. The following table shows the comparable volume of drug used in an 8 weekly maintenance phase:
| Body Weight Steps (kg) |
Dose Eculizumab (mg) |
Volume Eculizumab in 8 weeks (mg) | Dose Ravulizumab (mg) | Eculizumab tapering volumes |
| =5-10 | 300 | 900 | 600 | n/a |
| >10-20 | 300 | 1200 | 1200 | n/a |
| >20-30 | 600 | 2400 | 2100 | n/a |
| >30-40 | 900 | 3600 | 2700 | 1800 |
| >40-60 | 1200 | 4800 | 3000 | 1800 |
| >60-100 | 1200 | 4800 | 3300 | 1800 |
| >100 | 1200 | 4800 | 3600 | 1800 |
Where clinics have adjusted and tapered dose levels of eculizumab to suit patients’ needs and a protocol of 900mg every 4 weeks is acheived then volumes of drug used will be less than those for Ravulizumab. The alliance anticipates that such clinics will recalibrate their fundings and apply tapering protocols to Ravulizumab too.
Doctors should determine how long a patient needs Ravulizumab, but the alliance hopes that such decisions about withdrawal from Ravulizumab treatment should not only be based on the current evidence about safe withdrawal, but also should be made with the patient’s participation and with adequate monitoring put in place.
Note :Highlights of Ravulizumab use can be seen in this document https://alexion.com/Documents/Ultomiris_USPI.pdf
