Skip to main content

Mechanism of Action

ULTOMIRIS® binds specifically to C5 to inhibit terminal complement activity1

The precise mechanism by which ULTOMIRIS (ravulizumab-cwvz) exerts its therapeutic effect in gMG patients is not known.1

In gMG, the complement cascade causes damage at the NMJ2-4

Alteration of folds in the muscle membrane reduces the efficiency of neuromuscular transmission5

Healthy NMJ3,4,6

Microbiology image of typical folds in the muscle membrane

Typical folds in the muscle membrane

Complement
cascade leading to NMJ damage

NMJ With Complement-Mediated Damage3,4,7

Neuromuscular junction with complement mediated damage

Simplified membrane morphology

Circled areas indicate deposition of C9 (MAC component).



Healthy NMJ image: Reprinted from Mayo Clin Proc, 52(5), Engel AG, et al. 267-280. © 2009, with permission from Elsevier.

NMJ With Complement-Mediated Damage image: Sahashi K, et al. J Neuropathol Exp Neurol. 1980;39(2):160-172. © 1980 by permission of Oxford University Press.

ULTOMIRIS is the first and only long-acting complement C5 inhibitor1,8,9

ULTOMIRIS inhibits the complement protein C5—a key driver of damage to the NMJ in gMG.1,5

Flow chart illustrating the classical pathway of complement activation, including proximal complement, terminal complement, and C3 and C5 convertase

The precise mechanism by which ULTOMIRIS exerts its therapeutic effect in gMG patients is not known1

View Vaccination Requirements

 

ULTOMIRIS Mechanism of Action Video

Watch how this targeted gMG treatment inhibits the complement protein C5.1

gMG, generalized myasthenia gravis; MAC, membrane attack complex; NMJ, neuromuscular junction.

Hear from a gMG thought leader

Learn more about the complement system in patients with gMG.

Watch Video

IMPORTANT SAFETY INFORMATION INCLUDING BOXED WARNING

WARNING: SERIOUS MENINGOCOCCAL INFECTIONS

Life-threatening meningococcal infections/sepsis have occurred in patients treated with ULTOMIRIS. Meningococcal infection may become rapidly life-threatening or fatal if not recognized and treated early.

  • Comply with the most current Advisory Committee on Immunization Practices (ACIP) recommendations for meningococcal vaccination in patients with complement deficiencies.
  • Immunize patients with meningococcal vaccines at least 2 weeks prior to administering the first dose of ULTOMIRIS, unless the risks of delaying ULTOMIRIS therapy outweigh the risk of developing a meningococcal infection. See Warnings and Precautions for additional guidance on the management of the risk of meningococcal infection.
  • Vaccination reduces, but does not eliminate, the risk of meningococcal infections. Monitor patients for early signs of meningococcal infections and evaluate immediately if infection is suspected.

Because of the risk of serious meningococcal infections, ULTOMIRIS is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called ULTOMIRIS REMS.

Alexion Connect

Healthcare Professionals:
Answers to your questions are
a phone call away! Connect
with a live representative.
1-833-445-2111

Get Support

CONTRAINDICATIONS

  • Patients with unresolved Neisseria meningitidis infection.
  • Patients who are not currently vaccinated against Neisseria meningitidis, unless the risks of delaying ULTOMIRIS treatment outweigh the risks of developing a meningococcal infection.

WARNINGS AND PRECAUTIONS

Serious Meningococcal Infections

Life-threatening meningococcal infections have occurred in patients treated with ULTOMIRIS. The use of ULTOMIRIS increases a patient’s susceptibility to serious meningococcal infections (septicemia and/or meningitis). Meningococcal disease due to any serogroup may occur.

Vaccinate or revaccinate for meningococcal disease according to the most current ACIP recommendations for patients with complement deficiencies. Immunize patients without history of meningococcal vaccination at least 2 weeks prior to the first dose of ULTOMIRIS. Patients who initiate ULTOMIRIS treatment less than 2 weeks after receiving meningococcal vaccine(s) must receive appropriate prophylactic antibiotics until 2 weeks after vaccination.

In clinical studies, 2 adult patients with gMG were treated with ULTOMIRIS less than 2 weeks after meningococcal vaccination. All of these patients received antibiotics for prophylaxis of meningococcal infection until at least 2 weeks after meningococcal vaccination. The benefits and risks of antibiotic prophylaxis for prevention of meningococcal infections in patients receiving ULTOMIRIS have not been established. Consider discontinuation of ULTOMIRIS in patients who are undergoing treatment for serious meningococcal infection.

ULTOMIRIS REMS
Due to the risk of meningococcal infections, ULTOMIRIS is available only through a restricted program under a REMS called ULTOMIRIS REMS.

Under the ULTOMIRIS REMS, prescribers must enroll in the program. Prescribers must counsel patients about the risk of meningococcal infection/sepsis, provide the patients with the REMS educational materials, and ensure patients are vaccinated with meningococcal vaccines.

Additional information on the REMS requirements is available at www.ultomirisrems.com or 1-888-765-4747.

Other Infections
Patients may have increased susceptibility to infections, especially with encapsulated bacteria, such as infections caused by Neisseria meningitidis but also Streptococcus pneumoniae, Haemophilus influenzae, and to a lesser extent, Neisseria gonorrhoeae. If ULTOMIRIS is administered to patients with active systemic infections, monitor closely for worsening infection.

Thromboembolic Event Management
The effect of withdrawal of anticoagulant therapy during treatment with ULTOMIRIS has not been established. Treatment should not alter anticoagulant management.

Infusion-Related Reactions
Intravenous administration of ULTOMIRIS may result in systemic infusion-related reactions, including anaphylaxis and hypersensitivity reactions. In clinical trials, infusion-related reactions occurred in approximately 1% of patients treated with ULTOMIRIS. These events included lower back pain, drop in blood pressure, elevation in blood pressure, limb discomfort, drug hypersensitivity (allergic reaction), dysgeusia (bad taste), and drowsiness. These reactions did not require discontinuation of ULTOMIRIS. If signs of cardiovascular instability or respiratory compromise occur, interrupt ULTOMIRIS infusion and institute appropriate supportive measures.

ADVERSE REACTIONS
Most common adverse reactions in adult patients with gMG (incidence ≥10%) were diarrhea and upper respiratory tract infection. Serious adverse reactions were reported in 20 (23%) of patients treated with ULTOMIRIS and in 14 (16%) patients receiving placebo. The most frequent serious adverse reactions were infections reported in at least 8 (9%) patients treated with ULTOMIRIS and in 4 (4%) patients treated with placebo. Of these infections, one fatal case of COVID-19 pneumonia was identified in a patient treated with ULTOMIRIS and one case of infection led to discontinuation of ULTOMIRIS.

DRUG INTERACTIONS
Plasma Exchange, Plasmapheresis, and Intravenous Immunoglobulins
Concomitant use of ULTOMIRIS with plasma exchange (PE), plasmapheresis (PP), or intravenous immunoglobulin (IVIg) treatment can reduce serum ravulizumab concentrations and requires a supplemental dose of ULTOMIRIS.

Neonatal Fc Receptor Blockers
Concomitant use of ULTOMIRIS with neonatal Fc receptor (FcRn) blockers (e.g., efgartigimod) may lower systemic exposures and reduce effectiveness of ULTOMIRIS. Closely monitor for reduced effectiveness of ULTOMIRIS.

INDICATION
ULTOMIRIS is indicated for the treatment of adult patients with generalized myasthenia gravis (gMG) who are anti-acetylcholine receptor (AChR) antibody-positive.

Please see full Prescribing Information for ULTOMIRIS, including Boxed WARNING regarding serious and life-threatening meningococcal infections/sepsis.

References:

Reference:

  1. ULTOMIRIS. Prescribing information. Alexion Pharmaceuticals, Inc.
  1. Data on file. Alexion Pharmaceuticals, Inc.
  2. ULTOMIRIS. Prescribing information. Alexion Pharmaceuticals, Inc.
  1. Meisel A, et al; CHAMPION MG Study Group. J Neurol. 2023;270(8):3862-3875.
  2. Vu T, et al. NEJM Evid. 2022;1(5):1-22.
  3. VYVGART. Prescribing information. Argenx SE.
  4. ULTOMIRIS. Prescribing information. Alexion Pharmaceuticals, Inc.
  5. Data on file. Alexion Pharmaceuticals, Inc.
  1. Data on file. Alexion Pharmaceuticals, Inc.
  2. ULTOMIRIS. Prescribing information. Alexion Pharmaceuticals, Inc.
  3. Draft article 2.
  1. Data on file. Alexion Pharmaceuticals, Inc.
  2. ULTOMIRIS. Prescribing information. Alexion Pharmaceuticals, Inc.
  1. ULTOMIRIS. Prescribing information. Alexion Pharmaceuticals, Inc.
  2. Data on file. Alexion Pharmaceuticals, Inc.
  3. Muppidi S, et al; MG Composite and MG-QOL 15 Study Group. Muscle Nerve. 2011;44(5):727-731.
  4. Meisel A, et al; CHAMPION MG Study Group. J Neurol. 2023;270(8):3862-3875.
  5. Vu T, et al. NEJM Evid. 2022;1(5):1-22.
  1. ULTOMIRIS. Prescribing information. Alexion Pharmaceuticals, Inc.
  2. Kusner LL, et al. Ann N Y Acad Sci. 2012;1274(1):127-132.
  3. Meriggioli MN, et al. Lancet Neurol. 2009;8(5):475-490.
  4. Conti-Fine BM, et al. J Clin Invest. 2006;116(11):2843-2854.
  5. Howard JF Jr. Ann N Y Acad Sci. 2018;1412(1):113-128.
  6. Engel AG, et al. Mayo Clin Proc. 1977;52(5):267-280.
  7. Sahashi K, et al. J Neuropathol Exp Neurol. 1980;39(2):160-172.
  8. Kulasekararaj AG, et al. Blood. 2019;133(6):540-549.
  9. Lee JW, et al. Blood. 2019;133(6):530-539.
  10. Murphy K, et al. Janeway's Immunobiology. 9th ed. Garland Science, Taylor & Francis Group, LLC;2017:37-76.
  11. Rother RP, et al. Nat Biotechnol. 2007;25(11):1256-1264.
  1. ULTOMIRIS. Prescribing information. Alexion Pharmaceuticals, Inc.
  2. Meisel A, et al; CHAMPION MG Study Group. J Neurol. 2023;270(8):3862-3875.
  1. ULTOMIRIS. Prescribing information. Alexion Pharmaceuticals, Inc.
  2. Centers for Disease Control and Prevention. Updated February 7, 2022. Accessed June 23, 2023. https://www.cdc.gov/meningococcal/about/soliris-patients.html
  3. Mbaeyi SA, et al; Advisory Committee on Immunization Practices. Centers for Disease Control and Prevention; 2020. Accessed June 23, 2023. https://www.cdc.gov/mmwr/volumes/69/rr/rr6909a1.htm
  4. Centers for Disease Control and Prevention. Updated April 27, 2023. Accessed June 23, 2023. https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf
  5. Centers for Disease Control and Prevention. Updated October 12, 2021. Accessed June 23, 2023. https://www.cdc.gov/vaccines/vpd/mening/public
  6. Centers for Disease Control and Prevention. Updated October 18, 2022. Accessed June 23, 2023. https://www.cdc.gov/vaccines/vpd/mening/hcp/administering-vaccine.html
  1. ULTOMIRIS. Prescribing information. Alexion Pharmaceuticals, Inc.
  2. Meisel A, et al; CHAMPION MG Study Group. J Neurol. 2023;270(8):3862-3875.
  3. Data on file. Alexion Pharmaceuticals, Inc.
  4. Vu T, et al. NEJM Evid. 2022;1(5):1-12.
  5. Howard JF Jr, et al. Poster presented at: the 14th Myasthenia Gravis Foundation of America International Conference; May 10-12, 2022; Miami, FL.
  6. Habib AA, et al. Poster presented at: the American Association of Neuromuscular & Electrodiagnostic Medicine Annual Myasthenia Gravis Foundation of America Scientific Session; September 21, 2022; Nashville, TN.
  7. Jaretzki A III, et al. Neurology. 2000;55(1):16-23.
  1. ULTOMIRIS. Prescribing information. Alexion Pharmaceuticals, Inc.
  2. Data on file. Alexion Pharmaceuticals, Inc.
  3. Meisel A, et al; CHAMPION MG Study Group. J Neurol. 2023;270(8):3862-3875.
  1. ULTOMIRIS. Prescribing information. Alexion Pharmaceuticals, Inc.
  2. Conti-Fine BM, et al. J Clin Invest. 2006;116(11):2843-2854.