RxDecoder My Rx
‹ All drugs

eculizumab

Sold as Soliris. Class: Complement inhibitors. First FDA approval 03/16/2007: 19 years on the US market.

This grade answers one narrow question: how strong is the public evidence and safety record behind this drug, and how clean is its money trail and court record? It is not a verdict on whether the drug is right for you.

D

Score breakdown (60/100)

Safety ×35%
F
Evidence ×25%
D
Regulatory ×15%
B
Money & lawsuits ×15%
B
Options ×10%
C

Safety: 35

Evidence: 60

Regulatory history: 85

Money & lawsuits: 85

Options: 70

FDA boxed warning

WARNING: SERIOUS MENINGOCOCCAL INFECTIONS Eculizumab products, complement inhibitors, increase the risk of serious infections caused by Neisseria meningitidis [see Warnings and Precautions (5.1) ] . Life-threatening and fatal meningococcal infections have occurred in patients treated with complement inhibitors. These infections may become rapidly life-threatening or fatal if not recognized and treated early. Complete or update vaccination for meningococcal bacteria (for serogroups A, C, W, Y, and B) at least 2 weeks prior to the first dose of BKEMV, unless the risks of delaying therapy with BKEMV outweigh the risk of developing a serious infection. Comply with the most current Advisory Committee on Immunization Practices (ACIP) recommendations for vaccinations against meningococcal bacteria in patients receiving a complement inhibitor. See Warnings and Precautions (5.1) for additional guidance on the management of the risk of serious infections caused by meningococcal bacteria. Patients receiving eculizumab products are at increased risk for invasive disease caused by Neisseria meningitidis , even if they develop antibodies following vaccination. Monitor patients for early signs an...

What the FDA label says

Approved uses

is a complement inhibitor indicated for: The treatment of patients with paroxysmal nocturnal hemoglobinuria (PNH) to reduce hemolysis. ( 1.1 ) The treatment of patients with atypical hemolytic uremic syndrome (aHUS) to inhibit complement-mediated thrombotic microangiopathy. ( 1.2 ) Limitation of Use BKEMV is not indicated for the treatment of patients with Shiga toxin E. coli related hemolytic uremic syndrome (STEC-HUS). The treatment of generalized myasthenia gravis (gMG) in adult patients who are anti-acetylcholine receptor (AChR) antibody positive. ( 1.3 ) The treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive. ( 1.4 ) 1.1 Paroxysmal Nocturnal Hemoglobinuria (PNH) BKEMV is indicated for the treatment of patients with paroxysmal nocturnal hemoglobinuria (PNH) to reduce hemolysis. 1.2 Atypical Hemolytic Uremic Syndrome (aHUS) BKEMV is indicated for the treatment of patients with atypical hemolytic uremic syndrome (aHUS) to inhibit complement-mediated thrombotic microangiopathy. Limitation of Use BKEMV is not indicated for the treatment of patients with Shiga toxin E. coli related hemolytic uremic syndrome...

Contraindications

is contraindicated for initiation in patients with unresolved serious Neisseria meningitidis infection [see Warnings and Precautions (5.1) ] . BKEMV is contraindicated for initiation in patients with unresolved serious Neisseria meningitidis infection. ( 4 )

Warnings and precautions

Use caution when administering BKEMV to patients with any other systemic infection. ( 5.3 ) Infusion-Related Reactions: Monitor patients during infusion, interrupt for reactions, and institute appropriate supportive measures. ( 5.6 ) 5.1 Serious Meningococcal Infections Eculizumab products, complement inhibitors, increase a patient's susceptibility to serious, life-threatening, or fatal infections caused by meningococcal bacteria (septicemia and/or meningitis) in any serogroup, including non-groupable strains. Life-threatening and fatal meningococcal infections have occurred in both vaccinated and unvaccinated patients treated with complement inhibitors. The initiation of BKEMV treatment is contraindicated in patients with unresolved serious Neisseria meningitidis infection. Complete or update meningococcal vaccination (for serogroups A, C, W, Y and B) at least 2 weeks prior to administration of the first dose of BKEMV, according to current ACIP recommendations for patients receiving a complement inhibitor. Revaccinate patients in accordance with ACIP recommendations considering the duration of therapy with BKEMV. Note that ACIP recommends an administration schedule in patients rec...

Adverse reactions (label)

The following serious adverse reactions are discussed in greater detail in other sections of the labeling: Serious Meningococcal Infections [see Warnings and Precautions (5.1) ] Other Infections [see Warnings and Precautions (5.3) ] Monitoring Disease Manifestations after BKEMV Discontinuation [see Warnings and Precautions (5.4) ] Thrombosis Prevention and Management [see Warnings and Precautions (5.5) ] Infusion-Related Reactions [see Warnings and Precautions (5.6) ] The most frequently reported adverse reactions in the PNH randomized trial (≥ 10% overall and greater than placebo) are: headache, nasopharyngitis, back pain, and nausea. ( 6.1 ) The most frequently reported adverse reactions in aHUS single arm prospective trials (≥ 20%) are: headache, diarrhea, hypertension, upper respiratory infection, abdominal pain, vomiting, nasopharyngitis, anemia, cough, peripheral edema, nausea, urinary tract infections, pyrexia. ( 6.1 ) The most frequently reported adverse reaction in the gMG placebo-controlled clinical trial (≥ 10%) in adult patients is musculoskeletal pain. ( 6.1 ) The most frequently reported adverse reactions in the NMOSD placebo-controlled trial (≥ 10%) are: upper respir...

Recent major label changes

Indications and Usage ( 1.4 ) 06/2026 Dosage and Administration, ( 2.3 ) 06/2026 Dosage and Administration, ( 2.4 ) 11/2025 Dosage and Administration, ( 2.5 ) 06/2026

Source: FDA SPL label for BKEMV (Amgen Inc), effective 20260702. Full label on DailyMed.

Side-effect reports sent to the FDA

These are counts of reports people filed, not rates of harm. Anyone can file one, and nobody checks whether the drug was the cause. Millions of doses are taken for every report sent, so the useful part is how this drug compares with the average across all drugs.

46,862reports that mention this drug
46,858of those blame this drug, not another one the person was taking
61%of reports describe a serious outcome, such as a hospital stay (average for all drugs: 57%)
10.8%of reports include a death, from any cause (average for all drugs: 9.1%)

Problems reported most often

Fatigue · 4,994Off Label Use · 4,686Haemoglobin Decreased · 3,097Headache · 2,782Death · 2,477Pyrexia · 2,024Dyspnoea · 1,900Drug Ineffective · 1,825Asthenia · 1,803Nausea · 1,633Malaise · 1,622Platelet Count Decreased · 1,546Haemolysis · 1,542Hospitalisation · 1,361Blood Lactate Dehydrogenase Increased · 1,313

Reports per year

20192020202120222023202420252026
6,6532,3482,0512,0792,7502,7432,0101,188

Source: the FDA's Adverse Event Reporting System (FAERS). Reports are voluntary and unverified. Drugs that are prescribed a lot, in the news, or in lawsuits attract more reports, so the percentages are compared with the whole database to correct for that partly, not fully.

Recalls and regulatory record

2recall actions on file
0 / 0brand / generic applications
0label changes since 2021
YesREMS program
DateClassFirmReason
06/2014Class IAlexion Pharmaceuticals, Inc.Presence of Particulate Matter: Product failed the appearance for the presence of visible particles under labeled storage condition.
11/2013Class IAlexion Pharmaceuticals, Inc.Presence of Particulate Matter: Failed the appearance test for the presence of visible particles.

Class I = reasonable probability of serious harm. Class II = temporary or reversible harm. Class III = unlikely to harm. Most generic recalls are manufacturing or labeling defects for one lot, not a verdict on the molecule.

Evidence base

51randomized trials (PubMed)
23systematic reviews
157registered trials
66%of completed trials posted results
15%terminated or withdrawn
73%industry-funded

Independent Cochrane reviews

Counts measure how much evidence exists and how transparent it is, not how big the benefit is. For that, ask your prescriber: if 100 people like me took this, how many would get better because of it, and how many would be harmed? (Doctors call these the "number needed to treat" and "number needed to harm.") It differs by condition and is the number drug ads leave out. Sources: PubMed, ClinicalTrials.gov.

Money and lawsuits

In 2024, drug companies reported $531,178 in payments to US physicians and hospitals tied to this drug across 2,120 transactions (Soliris $531,178).

No pending federal MDL names this drug or its brands.

Not named in any federal pharmaceutical settlement of $100M or more on record.

Sources: CMS Open Payments (Sunshine Act); Judicial Panel on Multidistrict Litigation pending docket list; DOJ settlements as tabulated on Wikipedia with links to the primary record. State-court and individual suits are not included.

Who takes it and what it costs

419Medicare Part D patients (2024)
4,569prescriptions filled
$42,940average cost per fill
$196Mtotal Medicare spend

Same-class alternatives

2 drugs in the same class grade a letter or more higher than eculizumab on this site. Worth asking whether one of them would do the same job for you.

avacopancrovalimabdanicopaniptacopanpozelimabsutimlimabvilobelimabzilucoplan

Same ATC pharmacological class, graded ones first, best grade at the top. Being in the same class does not make them interchangeable for your condition; it makes them worth asking about.

Questions to ask your prescriber

  1. This drug carries a boxed warning. Which specific risk does it cover, and does it apply to me?
  2. This drug has a REMS safety program. What monitoring does that require from us?
  3. The most-reported problems in FDA's adverse event data are fatigue, haemoglobin decreased, headache. How would we recognize and handle those?
  4. Off-label use is among the most-reported items for this drug. Is my use on-label, and if not, what evidence supports it?
  5. Why this one over avacopan, crovalimab, danicopan? What would make you pick one of those instead?
  6. There is no generic. Is there an older generic in the same class that works as well for my situation?
  7. What result are we expecting, by when, and what is the plan if it does not happen?
  8. If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)