How does Empaveli compare to Soliris?
While both Empaveli and Soliris are complement inhibitors used to treat conditions involving abnormal red blood cell destruction, they target different components of the complement system and have distinct differences.
Empaveli vs Soliris
Empaveli (pegcetacoplan):
- C3 complement inhibitor targeting higher up the cascade
- Prevents both IVH and EVH (complete red blood cell protection)
- More effective than Soliris for PNH treatment
- Self-administered subcutaneous injection at home
- Treats PNH, C3 glomerulopathy (C3G), or primary immune-complex membranoproliferative glomerulonephritis (IC-MPGN).
Soliris (eculizumab):
- C5 complement inhibitor (terminal complement blocker)
- Prevents only IVH, not EVH (partial protection)
- Healthcare professional-administered infusion every 2 weeks
- Broader indications: PNH, atypical hemolytic uremic syndrome (HUS), generalized Myasthenia Gravis (gMG), or neuromyelitis optica spectrum disorder (NMOSD)
- Given by infusion under the guidance of a healthcare professional every 2 weeks (after the initial dosing schedule)
- Often replaced by Ultomiris (7 infusions/year)
Key difference:
Empaveli provides superior PNH protection by targeting both types of hemolysis, while Soliris has broader therapeutic applications but limited hemolysis coverage.
Is there a difference in side effects between Empaveli and Soliris?
Empaveli is more likely than Soliris to cause:
- Injection site reactions
- Diarrhea.
Empaveli is less likely than Soliris to cause:
- Breakthrough hemolysis
- Headache
- Fatigue.
There were no cases of meningitis in either group.
71% of people receiving Empaveli experienced normalization of their lactate dehydrogenase levels (LDH) levels within the first 4 weeks that persisted for 16 weeks in one trial, compared to only 15% receiving Soliris.
What are Empaveli and Soliris used for?
Empaveli and Soliris are prescription medicines approved to treat adults with paroxysmal nocturnal hemoglobinuria (PNH).
- PNH is a rare acquired, life-threatening disease of the blood that is characterized by the destruction of red blood cells (hemolytic anemia), blood clots (thrombosis), and impaired bone marrow function.
Empaveli is also used to treat C3G and IC-MPGN.
Soliris is also be used to treat:
- Atypical HUS (adults and children)
- gMG who are anti-acetylcholine receptor antibody-positive (adults and children)
- NMOSD who are anti-aquaporin-4 antibody positive (adults).
Related questions
How are Empaveli and Soliris administered?
Empaveli is administered by subcutaneous (just under the skin) infusion and Soliris is given by intravenous infusion (into a vein). This makes Empaveli more convenient for home use than Soliris.
Empaveli:
- Subcutaneous injection every 2 weeks
- Self-administered at home using wearable injector on stomach (allows mobility)
- Can be given by healthcare provider into stomach, thighs, hips, or upper arms.
Soliris:
- Intravenous infusion by healthcare professional
- Weekly for 5 weeks, then every 2 weeks
- Most patients switch to Ultomiris (same ingredient, long-acting), because Ultomiris requires only 7 infusions yearly, each taking under 1 hour.
What do Empaveli and Soliris contain?
Empaveli contains pegcetacoplan and Soliris contains eculizumab.
How do Empaveli and Soliris work?
Both medications block the complement system, which can mistakenly destroy healthy red blood cells in certain conditions.
Empaveli targets protein C3 early in the complement cascade, preventing red blood cell destruction both in the bloodstream and organs (spleen, liver). It's the only treatment that stops both types of destruction.
Soliris targets protein C5 later in the cascade, preventing red blood cell destruction only in the bloodstream, not in organs.
Key difference: Empaveli provides complete protection by working upstream, while Soliris offers partial protection downstream.
References
- Soliris Prescribing Information. https://alexion.us/-/media/alexion_global/documents/regulatory/north-america/usa/2024/english/soliris_uspi.pdf
- Ultomiris Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/761108s037lbl.pdf
- Empaveli Prescribing Information. https://pi.apellis.com/files/PI_Empaveli.pdf
- Hillmen P, Szer J, Wietz I, et al. Pegcetacoplan versus Eculizumab in Paroxysmal Nocturnal Hemoglobinuria N Engl J Med 2021;384:1028-37. DOI: 10.1056/NEJMoa2029073
Read next
How does Ultomiris compare to Soliris for PNH?
Ultomiris (ravulizumab) and Soliris (eculizumab) are both C5 complement inhibitors approved to treat patients with paroxysmal nocturnal hemoglobinuria (PNH), a blood disease caused by red blood cell destruction. Ultomiris has a longer half-life, meaning it stays in your blood longer and does not have to be dosed as often. Continue reading
How does Soliris work for PNH?
Soliris works by binding to the complement protein C5. This helps stop the activation of C5a / C5b and prevents formation of terminal complement complex C5b-9. Clinically, Soliris helps to stop red blood cell destruction and symptoms like anemia, fatigue and blood clots in patients living with paroxysmal nocturnal hemoglobinuria (PNH). Continue reading
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Mestinon is a prescription medicine that can help relieve symptoms of myasthenia gravis (MG) such muscle weakness, double vision, blurred vision, drooping eyelids, loss of facial expressions, and difficulties with talking, chewing food, swallowing and breathing. There is no cure for MG, but treatments can help with symptoms. Continue reading
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