Better quality of life in aHUS with Ultomiris vs. Soliris, review finds
Similar effectiveness for 2 therapies, but fewer doses needed with Ultomiris
Both Soliris (eculizumab) and Ultomiris (ravulizumab) are safe, and have similar effectiveness in improving kidney function and blood parameters in people with atypical hemolytic syndrome (aHUS), according to a new systematic review study.
However, Ultomoris “was preferred by a majority of the patients as it only has to be dosed once every eight weeks,” the researchers wrote. Soliris is given once every two weeks.
Less frequent dosing was tied to a reduced financial burden and a better quality of life for patients and their caregivers. Among the benefits of Ultomiris versus Soliris was “a total saving of 73% in … annual lost productivity costs,” the team noted.
Overall, “94% of adult patients and all caregivers reported a preference for [Ultomoris],” the researchers wrote.
The study, “Eculizumab Versus Ravulizumab for the Treatment of Atypical Hemolytic Uremic Syndrome: A Systematic Review,” was published in the journal Cureus.
Soliris approved in 2011, Ultomiris in 2019
aHUS is caused by the abnormal activity of the complement cascade, a part of the body’s immune system. This leads to the formation of blood clots in small blood vessels, which can damage organs, particularly the kidneys.
Mutations in specific genes regulating the activity of the complement cascade can predispose a person toward developing aHUS. But typically a trigger event, such as an infection, also is needed for the disease to manifest.
Soliris, approved in the U.S. in 2011, and Ultomiris, which earned its U.S. approval in 2019, are both antibody-based therapies for aHUS. Both work by binding to a complement protein called C5 to stop excessive complement activation.
Now, a duo of researchers sought to compare the efficacy of the two therapies. To that end, they conducted a systematic review and meta-analysis of published studies reporting the outcomes of Soliris and Ultomiris treatment in people with aHUS.
A total of 13 studies, published between 2015 and 2023, were selected for the analysis.
The results showed that Soliris was associated with kidney function improvements, and led to reductions in the levels of creatinine — a marker of kidney dysfunction — and lactate dehydrogenase, a marker of tissue damage. It also helped normalize platelet counts, or cell fragments that help the blood to clot.
One of the studies also showed that early treatment — starting Soliris less than seven days after the onset of aHUS symptoms — was tied to a greater increase in glomerular filtration rate (eGFR), which reflects the kidneys’ abilities to filter out waste. The proportion of patients seeing their platelet counts normalize also was higher when Soliris was used in the first seven days following the onset of symptoms than when it was started later on (86% vs 55%).
When used as a preventive treatment, Soliris was able to lower the rate of disease recurrence.
Certain treatment parameters better with Soliris vs. Ultomiris
Ultomiris was similarly effective at normalizing blood parameters, with a study showing 53.6% of the patients achieving this outcome within a median of 86 days. Treatment also increased eGFR in 68.1% of the patients.
“One benefit of [Ultomiris] is the low dosing frequency limited to once every eight weeks, which reduces the treatment burden on the patients and their families,” the researchers wrote.
A study indirectly comparing the efficacy of both antibodies found that after around six months of treatment, there was a higher percentage of patients on Ultomiris requiring dialysis than those on Soliris (22% vs. 8%). However, patients treated with Ultomiris had a better mean eGFR.
Further, complete normalization of blood parameters was attained by 70% of the patients on Soliris and by 61% of those on Ultomiris.
Considering treatment impact on patients’ quality of life, one study reported that Ultomiris had fewer effects on patients’ daily lives (4% vs. 72%) and ability to go to school and/or work (5.7% vs. 60%) compared with Soliris. Additionally, more than 9 in 10 adult patients and all caregivers reported having a preference for Ultomiris.
One benefit of [Ultomiris] is the low dosing frequency limited to once every eight weeks, which reduces the treatment burden on the patients and their families.
According to researchers, “this could be attributed to the dosing frequency of [Ultomiris] (once every four to eight weeks) and [Soliris] (once every two weeks).”
Additional analyses also showed that, over the course of one year, patients on Soliris spent much more time receiving the medication than did those on Ultomiris. That resulted in the lower costs of lost productivity seen with Ultomiris versus Soliris.
Overall, these findings led researchers to conclude that Soliris and Ultomiris “are comparable in safety and efficacy,” regardless of patients’ preferences for their use.
The team noted, however, that “blinded, double-arm, clinical trials preferably with larger sample sizes are needed to effectively compare both [therapies].”