Zilucoplan

Extended indication	Generalized Myasthenia Gravis
Therapeutic value	No estimate possible yet
Registration phase	Registration application pending

Product

Active substance	Zilucoplan
Domain	Neurological disorders
Reason of inclusion	New medicine (specialité)
Main indication	Muscular diseases other
Extended indication	Generalized Myasthenia Gravis
Manufacturer	UCB
Portfolio holder	UCB
Route of administration	Subcutaneous
Therapeutical formulation	Injection
Budgetting framework	Extramural (GVS)
Centre of expertise	LUMC / MUCM+ / AUMC (loc. AMC)
Additional remarks	Mechanism of Action: zilucoplan is a synthetic macrocyclic peptide inhibitor of the terminal complement protein C5, with potential anti-inflammatory and cell protective activities. Upon subcutaneous administration, complement inhibitor zilucoplan binds to a unique site in terminal complement protein C5, which blocks C5 cleavage into C5a and C5b and prevents the C5b-dependent assembly of the membrane-attack complex (MAC). Zilucoplan also inhibits the interaction between C5b and C6, thereby further blocking MAC assembly.

Registration

Registration route	Centralised (EMA)
Type of trajectory	Normal trajectory
ATMP	No
Submission date	September 2022
Expected Registration	October 2023
Orphan drug	Yes
Registration phase	Registration application pending
Additional remarks	submission date expected late second half of 2022

Therapeutic value

Current treatment options	Cholinesterase inhibitors, corticosteroids, Immunosuppressants, Intravenous, Immunoglobulins, bloodplasma transfer, Rituximab, Eculizumab
Therapeutic value	No estimate possible yet
Substantiation	Fase 2 studie afgerond. In vergelijking met placebo laat het geneesmiddel positieve resultaten zien (1). Een fase 3 studie zou verder uitsluitsel moeten geven over de therapeutische waarde van dit geneesmiddel ten opzichte van andere beschikbare geneesmiddelen (2). Op basis van de beschikbare data wordt op dit moment verwacht dat de nieuwe complementremmers ongeveer gelijk zullen presteren aan eculizumab.
Frequency of administration	1 times a day
Dosage per administration	tbd
References	Howard JF Jr, Nowak RJ, Wolfe GI, et al. Clinical Effects of the Self-administered Subcutaneous Complement Inhibitor Zilucoplan in Patients With Moderate to Severe Generalized Myasthenia Gravis: Results of a Phase 2 Randomized, Double-Blind, Placebo-Controlled, Multicenter Clinical Trial. JAMA Neurol. 2020;77(5):582-592. doi:10.1001/jamaneurol.2019.5125, (NCT03315130, fase 2) (1), Studie-opzet fase 3-studie (NCT04115293) (2); NCT03971422)

Expected patient volume per year

Patient volume	< 1,750 Market share is generally not included unless otherwise stated.
References	1) Spierziekten Nederland;
Additional remarks	In Nederland wordt de prevalentie van gegeneraliseerde Myasthenia Gravis (gMG) patiënten geschat op 1 op 10.000 inwoners. Dit komt overeen met 1.750 patiënten uitgaande van 17,5 miljoen inwoners (1).

Patient volume

< 1,750

Market share is generally not included unless otherwise stated.

References

1) Spierziekten Nederland;

Additional remarks

In Nederland wordt de prevalentie van gegeneraliseerde Myasthenia Gravis (gMG) patiënten geschat op 1 op 10.000 inwoners. Dit komt overeen met 1.750 patiënten uitgaande van 17,5 miljoen inwoners (1).

Expected cost per patient per year

There is currently nothing known about the expected cost.

Potential total cost per year

There is currently nothing known about the possible total cost.

Off label use

There is currently nothing known about off label use.

Indication extension

There is currently nothing known about indication extensions.

Other information

There is currently no futher information available.