Zilucoplan (Zilbrysq)

Key Messages

• Canada’s Drug Agency (CDA-AMC) recommends that Zilbrysq be reimbursed by public drug plans for the treatment of generalized myasthenia gravis (gMG) in adult patients who are anti–acetylcholine receptor (AChR) antibody positive and who continue to receive standard therapy if certain conditions are met.
• Zilbrysq should only be covered to treat adult patients who have received treatment for at least 1 year with 2 or more immunosuppressant therapies; or who have a history of treatment with at least 1 immunosuppressant for 1 year or more, and chronic plasma exchange, IV immunoglobulin, or subcutaneous immunoglobulin at least every 3 months for 12 months. Eligible patients should test positive for AChR antibodies, have a Myasthenia Gravis Activities of Daily Living (MG-ADL) score (which estimates patients’ ability to perform activities of daily living; score ranges from 0 to 24, with higher scores indicating more impairment) of 6 or greater, and meet the Myasthenia Gravis Foundation of America (MGFA) classification (which categorizes clinical features by increasing severity) of II (mild weakness affecting body muscles and may also include weakness in the eye muscles) to IV (severe weakness affecting body muscles and may also include weakness in the eye muscles).
• Zilbrysq should not be given during a gMG exacerbation (moment when patient experiences weakness in some or all muscles, without needing assistance to breath) or crisis (moment when respiratory muscles are too weak, limiting air flow in and out of lungs, as a result patient is unable to breathe), or within 12 months of thymectomy (surgical removal of thymus gland). Zilbrysq should only be reimbursed if prescribed by or in consultation with a neurologist with expertise in managing patients with gMG and the cost of Zilbrysq is reduced. Zilbrysq should not be used concomitantly with rituximab, efgartigimod alfa, or complement inhibitors, such as eculizumab.