Real Life Use of Ravulizumab in Italian Patients With Paroxysmal Nocturnal Hemoglobinuria

Real Life Use of Ravulizumab in Italian Patients With Paroxysmal Nocturnal Hemoglobinuria a Multicenter Observational Retrospective and Prospective Cohort Study.

This study will collect clinical response data on participants who were already treated with eculizumab for at least 26 weeks and who started ravulizumab treatment as a specific therapeutic strategy as per ordinary clinical practice.

Study Overview

• Status: Completed
• Conditions: Paroxysmal Nocturnal Hemoglobinuria
• Intervention / Treatment: Drug: Ravulizumab

Detailed Description

This study is an Italian multi-center, observational (non-interventional), cohort study composed of both retrospective and prospective observation periods on the same Paroxysmal Nocturnal Hemoglobinuria (PNH) participants. After the First Participant In from different Italian study centers, participants will be consecutively enrolled for 9 months and they will be observed for 52 weeks after the start of ravulizumab.

• Study Type: Observational
• Enrollment (Actual): 120

Contacts and Locations

Study Locations

• Italy
  • Brescia, Italy
    • Clinical Trial Site
  • Catania, Italy
    • Clinical Trial Site
  • Lecce, Italy
    • Clinical Trial Site
  • Ragusa, Italy
    • Clinical Trial Site
  • Roma, Italy
    • Clinical Trial Site
  • Salerno, Italy
    • Clinical Trial Site

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Participants with documented diagnosis of PNH that were already treated with eculizumab and started treatment with ravulizumab and met the inclusion and exclusion criteria.

Description

Inclusion Criteria:

• Body weight of 10 kilogram or above
• Hemolysis with clinical symptom(s) indicative of high disease activity
• Documented diagnoses of PNH confirmed by high-sensitivity flow cytometry evaluation of red blood cells and white blood cells with granulocyte or monocyte clone size of ≥ 5%
• Clinically stable after having been treated with eculizumab for at least the past 6 months
• Participant already assigned to ravulizumab treatment as a specific therapeutic strategy within the current routine clinical practice (this decision has to be made independently and before the enrolment of the participant in the study)
• Vaccinated against Neisseria meningitidis (according to Summary of Product Characteristics) < 3 years before dosing or at least 2 weeks prior to initiating ravulizumab unless the risk of delaying ravulizumab therapy outweighs the risk of developing a meningococcal infection
• Signed written informed and privacy consent prior to study participation

Exclusion Criteria:

• History of hematopoietic stem cell transplantation (evaluated at baseline)
• Known pregnant or breastfeeding participant (evaluated at baseline)
• Participant unable to read and write in Italian language and to autonomously fill in questionnaires and scales (evaluated at enrolment)
• Participants enrolled in any clinical study receiving experimental treatments for PNH (evaluated at baseline)
• Hypersensitivity to the active substance or to any of the excipient of the study drug.
• Participants with unresolved N. meningitidis infection at treatment initiation
• Participants who are not currently vaccinated against N. meningitidis unless they receive prophylactic treatment with appropriate antibiotics until 2 weeks after vaccination

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Other

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Participants With PNH; Data will be collected on participants who were already treated with eculizumab for at least 26 weeks and who started ravulizumab treatment as per clinical practice.	Drug: Ravulizumab; Participants will be observed for 52 weeks after the start of ravulizumab.; Other Names: Ultomiris

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage Change In Lactate Dehydrogenase (LDH) From Baseline To End Of Observation	The analysis using descriptive statistics will be performed on the Full Analysis Set, including the participants having the LDH evaluation at both the baseline and at the end of observation.	Baseline through up to Week 52

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage Change In LDH From Baseline To End Of Observation On Participants Treated With Ravulizumab With Respect To The Observed Treatment Period With Eculizumab	The difference of percentage change in LDH from baseline to end of observation will be calculated on participants treated with ravulizumab (over the 52 weeks after baseline) and on the same participants treated with eculizumab (during up to 52 weeks before baseline).	Baseline through up to Week 52
Number of Transfusions During Treatment Period With Ravulizumab	The number of participants who needed transfusions, with relative frequency and percentage, and descriptive statistics on the total number of transfusions (number of packed red blood cell units transfused) will be calculated for both the treatment period with ravulizumab and the treatment period with eculizumab.	Baseline through up to Week 52
Total Number Of Transfusion Sessions During The Treatment Period With Ravulizumab	The number of participants who needed transfusions, with relative frequency and percentage, and descriptive statistics on the number of transfusion sessions (number of days) will be calculated for both the treatment period with ravulizumab and the treatment period with eculizumab.	Baseline through up to Week 52
Number Of Participants Undergoing Ravulizumab Without A ≥ 2 gram/deciliter (g/dL) Decrease In Hemoglobin Level In The Absence Of Transfusion	The proportion of participants without a ≥ 2 g/dL decrease in hemoglobin level in the absence of transfusion will be calculated for both the treatment period with ravulizumab and the treatment period with eculizumab.	Baseline through up to Week 52
Breakthrough Hemolysis (BTH) In The Presence Of Elevated LDH During Treatment Period With Ravulizumab	BTH is defined as at least 1 new or worsening symptom or sign of intravascular hemolysis (fatigue, hemoglobinuria, abdominal pain, dyspnea, anemia [hemoglobin < 10 g/dL], major adverse vascular event including thrombosis, dysphagia, or erectile dysfunction) in the presence of elevated LDH ≥ 2 * upper limit of normal (ULN) after prior LDH reduction to < 1.5 * ULN while on therapy.	Baseline through up to Week 52
Change From Baseline To Each Timepoint Of Assessment Using Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale	The FACIT-Fatigue is a 13-item questionnaire that assesses self-reported fatigue and its impact upon daily activities and function over the preceding 7 days. Participants will score each item on a 5-point scale. Total scores range from 0 to 52, with a higher score indicating better Quality of Life (QoL).	Baseline through up to Week 52
Change From Baseline To Each Timepoint Of Assessment Using European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 Scale	EORTC is a questionnaire developed to assess the QoL of cancer participants over the preceding 7 days. The questionnaire has 30 questions related to QoL, with the first 28 questions scored on a 4-point scale and the final 2 questions that probe the participant's overall health and QoL scored on a scale of 1 (very poor) to 7 (excellent). Each subscale has a range of 0 to 100%. Thus, a high score for a functional scale represents a high/healthy level of functioning, a high score for the global health status/QoL represents a high QoL, but a high score for a symptom scale/item represents a high level of symptomatology/problem.	Baseline through up to Week 52
PNH-specific Patient Preference Questionnaire (PPQ)	PNH-PPQ is a participant-centered approach for evaluating preferences for the treatment of PNH. It contains 11 questions assessing overall treatment preference, evaluating treatment preference according to 9 treatment characteristics, assessing the most important treatment characteristic for participant overall medication preference, and evaluating those same aspects of treatment with ravulizumab.	Week 52
Number of Participants Experiencing Adverse Events (AEs)	An AE is any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. AEs that will occur during the ravulizumab treatment will be collected and will be reported to the Investigator or qualified designee by the participant.	Baseline through up to Week 52
Costs Related to PNH Sustained By National Health System (NHS) For Ravulizumab Treatment	The following medical costs related to PNH sustained by NHS will be collected: specialist visits, pharmacological and non-pharmacological treatments, hospital and emergency rooms admissions, and examinations (by examination type). This will be reported through descriptive statistics and will be appraised considering the quantity of resource consumption by medical resources and its unit costs.	Baseline, Weeks 18, 34, and 52
Costs Sustained By The Participants Related To The Infusion Visits For Ravulizumab Treatment	The following costs sustained by the participants related to the infusion visits will be collected: average cost to reach the structure, overall time required for the infusion (time to reach the structure + time of infusion), retirement status of the participant, loss of working days, and need of a caregiver. This will be calculated in terms of the total cost of transport and overall time required for infusion.	Baseline, Weeks 18, 34, and 52

Collaborators and Investigators

• Sponsor: Alexion Pharmaceuticals, Inc.

Publications and helpful links

General Publications

• Iori AP, De Vivo A, Di Bona E, Caocci G, Fioritoni F, Ciceri F, Beggiato E, Rapezzi D, Amendola A, Figuera A, Selleri C, Longu F, Fattizzo B, Tucci A, Cignetti A, Amico V, Sica S, Metafuni E, Raso S, Urbano TA, Marano L, Di Renzo N, Spedini P, Rambaldi A, Lanza F, Clissa C, Danesin C, Greve MB, Cabibbo S, Ori A, Cassanelli F, Sottana F, Campolo B, Gasparri G, Carini F, Barcellini W. Real life use of ravulizumab in Italian patients with paroxysmal nocturnal hemoglobinuria: evidence from the REACTION observational study. Ann Hematol. 2026 Jan 22;105(2):50. doi: 10.1007/s00277-026-06792-w.

Helpful Links

• Related Info

Study record dates

Study Major Dates

• Study Start (Actual): June 17, 2022
• Primary Completion (Actual): June 30, 2024
• Study Completion (Actual): March 24, 2025

Study Registration Dates

• First Submitted: March 2, 2022
• First Submitted That Met QC Criteria: March 2, 2022
• First Posted (Actual): March 10, 2022

Study Record Updates

• Last Update Posted (Actual): May 7, 2026
• Last Update Submitted That Met QC Criteria: May 4, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: Safety; Efficacy; Patient Registry; CD59; PIGA Gene; Complement-inhibitor Protein; CD55
• Additional Relevant MeSH Terms: Hematologic Diseases; Bone Marrow Diseases; Anemia, Hemolytic; Anemia; Myelodysplastic Syndromes; Hemic and Lymphatic Diseases; Hemoglobinuria, Paroxysmal; Immunosuppressive Agents; Immunologic Factors; Physiological Effects of Drugs; Complement Inactivating Agents; ravulizumab
• Other Study ID Numbers: HEMRAV601IT

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Alexion has a public commitment to allow requests for access to study data and will be supplying a protocol, CSR, and plain language summaries.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No