Crovalimab: A Novel Approach in the Management of Paroxysmal Nocturnal Hemoglobinuria

Abstract

Background and aims: Paroxysmal Nocturnal Hemoglobinuria (PNH) is a rare acquired clonal blood disorder caused by mutations in the PIGA gene, leading to complement-mediated hemolysis. Currently available terminal complement inhibitors, such as Eculizumab and Ravulizumab, pose several challenges, including the need for frequent intravenous infusions and the potential for resistance due to C5 polymorphisms. This study highlights the clinical significance of Crovalimab, a novel C5 inhibitor developed using SMART-antibody technology, as a promising alternative.

Methods: An extensive literature review was conducted using PubMed to evaluate the pharmacological properties, mechanism of action, and clinical trial data of Crovalimab. Phase 3 trials-COMMODORE 1, 2, and 3-were analyzed to assess Crovalimab's safety, efficacy, and potential benefits in both C5-inhibitor naïve and previously treated patients.

Results: Crovalimab demonstrated high bioavailability, an extended half-life, and subcutaneous administration every 4 weeks, offering a better alternative to intravenous therapies. Unlike existing treatments, Crovalimab targets the C5 β-chain, making it effective even in patients with the R885H polymorphism. The COMMODORE trials reported favorable outcomes, including effective hemolysis control, reduced transfusion dependence, and a manageable safety profile. Adverse events were mostly mild, with rare occurrences of transient immune complex reactions.

Conclusion: Crovalimab represents a significant advancement in the management of PNH, with the potential to reduce treatment burden while maintaining efficacy. However, further research is required to evaluate its long-term safety and effectiveness across diverse populations.

Keywords: FDA approval; SMART antibody; crovalimab; drug‐target‐drug complexes (DTDCs); paroxysmal nocturnal hemoglobinuria (PNH).