Ravulizumab — Drug Monograph

Brand names: Ultomiris

Drug class: Monoclonal Antibody

Mechanism of Action

Long-acting humanized monoclonal antibody against complement C5, engineered from eculizumab with amino-acid substitutions that enhance recycling via the neonatal Fc receptor. Like eculizumab it blocks cleavage of C5 and formation of the terminal membrane attack complex (C5b-9), but its prolonged half-life allows every-8-week maintenance dosing while providing equivalent, sustained terminal complement inhibition in aHUS and PNH.

FDA Indications

• Atypical hemolytic uremic syndrome (aHUS) to inhibit complement-mediated thrombotic microangiopathy
• Paroxysmal nocturnal hemoglobinuria (PNH)
• Generalized myasthenia gravis (anti-AChR antibody positive)
• Neuromyelitis optica spectrum disorder (anti-AQP4 antibody positive)

Common Side Effects

• Headache
• Upper respiratory infection
• Diarrhea
• Nausea
• Fatigue
• Hypertension

Clinical Pearl

Ravulizumab is the long-acting successor to eculizumab: the same C5-blocking mechanism re-engineered for every-8-week maintenance dosing instead of every 2 weeks, dramatically reducing infusion burden with equivalent efficacy in aHUS and PNH. It carries the identical meningococcal-infection boxed warning, vaccination requirement, and REMS obligations.

Related Therapies & Mechanisms

• Eculizumab (Soliris) — Monoclonal Antibody · PNH
• Caplacizumab (Cablivi) — Monoclonal Antibody · Supportive Care
• Crovalimab (Piasky) — Monoclonal Antibody · PNH
• Pozelimab (Veopoz) — Monoclonal Antibody · Supportive Care