Real-World Insights: Switching from Eculizumab to Ravulizumab in Paroxysmal Nocturnal Hemoglobinuria

Switching adults with PNH from eculizumab to ravulizumab preserved biochemical and clinical disease control while substantially extending dosing intervals, according to a prospective multicenter series from Denmark and Finland.

The report prospectively followed 20 adults who transitioned from long-term eculizumab to ravulizumab. Laboratory comparisons used the three months before and after the switch, and transfusions and breakthrough hemolysis (BTH) were tracked for 12 months pre- and post-switch. Patients were drawn from four Danish hospitals and one Finnish center, with a median prior eculizumab exposure of 4.6 years. Endpoints included lactate dehydrogenase (LDH), reticulocyte counts, hemoglobin-related outcomes, BTH episodes, transfusion requirements, short-term safety events, and operational metrics tied to dosing intervals and resource use.

Efficacy signals favored maintained disease control: 19 of 20 patients had stable or reduced transfusion needs and BTH burden in the 12 months after switching, and 11 patients experienced neither transfusions nor BTH in the year before and after the change. Most patients showed unchanged LDH and reticulocyte values in the three-month laboratory windows; three had numerically lower LDH post-switch, and a minority demonstrated individual variation. Collectively, the numerical pattern supports preserved hemolysis control overall, with the largest clinical gains among patients who had higher baseline hemolysis or transfusion needs.

Safety findings in this short-term follow-up were reassuring but limited by sample size and duration. No meningococcal disease was reported; vaccination practices were not detailed. There were no adverse events clearly attributed to ravulizumab that required treatment cessation, and no new cluster of serious infections compared with patients’ pre-switch experience on eculizumab during the 12-month surveillance window.

Extended dosing intervals produced clear operational advantages: most patients moved from biweekly infusions to the standard ravulizumab schedule of every eight weeks, markedly reducing clinic visits and infusion frequency. The authors cite an illustrative patient who saved roughly 22 hospital trips despite two additional transfusions during the same period.

Patient-reported and clinician-observed feedback emphasized reduced treatment burden and likely benefits for adherence and resource use; these observations were descriptive and were not tested in formal cost-effectiveness models.

Key Takeaways:

• Real-world data (N=20) show preserved or improved disease control after switching from eculizumab to ravulizumab, with 19/20 patients having stable or reduced transfusions and BTH.
• Safety signals were limited in 12-month follow-up and no meningococcal disease was reported; vaccination details were not provided.
• Extended eight-week dosing reduced infusion burden and produced tangible operational benefits, though formal economic validation is needed.