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Eculizumab is a recombinant humanized monoclonal antibody that targets complement protein C5. By binding to C5, it prevents its cleavage into C5a and C5b and inhibits the formation of the terminal complement complex (C5b-9), also known as the membrane attack complex (MAC). This action blocks terminal complement activation, reducing hemolysis in paroxysmal nocturnal hemoglobinuria (PNH), microangiopathy in atypical hemolytic uremic syndrome (aHUS), and immune-mediated inflammation in neuromyelitis optica spectrum disorder (NMOSD) and generalized myasthenia gravis. Eculizumab was developed by Alexion Pharmaceuticals and first approved by the FDA in 2007 for PNH. It is indicated for PNH, aHUS, anti-acetylcholine receptor antibody-positive generalized myasthenia gravis, and anti-aquaporin-4 antibody-positive NMOSD[1][2][3][4][5].
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