Zilucoplan

How it works

This macrocyclic peptide binds complement component C5, blocking its cleavage and preventing formation of the membrane attack complex, thereby protecting the neuromuscular junction from complement-mediated damage.

Prescribing in practice

• By inhibiting terminal complement it markedly increases susceptibility to meningococcal and other encapsulated-organism infections, so meningococcal vaccination is required before starting and patients must be counselled to seek urgent care for signs of meningitis.
• It is given as a daily self-administered subcutaneous injection and patients should be trained in proper technique.
• It may be used alongside other myasthenia treatments under specialist supervision.

Monitoring

Ensure meningococcal vaccination is up to date and monitor for signs of serious infection and for clinical response of myasthenic symptoms.

Counselling the patient

• Get any recommended meningococcal vaccinations and carry a patient safety card, seeking urgent care for fever, severe headache or neck stiffness.
• Learn and follow the correct technique for the daily subcutaneous injection.

Evidence & guidelines

Its efficacy in anti-AChR-positive generalised myasthenia gravis was shown in the RAISE randomised controlled trial.