Supplemental dosing
Two patients received PLEX/PP interventions during the maintenance treatment phase of the study (one patient received four PLEX/PP interventions, and the other received two); both received subsequent weight-based supplemental ravulizumab doses of 1800 mg within 4 h after the end of each PLEX/PP intervention. For each instance of PLEX/PP, the prescribed supplemental dose successfully offset the marked decline in serum ravulizumab concentration, while not exceeding the maximum observed ravulizumab concentrations observed for these patients at other points in the study. Five patients received IVIg interventions during the maintenance treatment phase (one patient received three courses of IVIg on separate occasions, and the other four patients each received one course of IVIg). All five patients were administered supplemental ravulizumab doses of 600 mg within 4 h after completing the last IVIg infusion of the course, which offset the increased clearance of ravulizumab following IVIg rescue treatment and maintained ravulizumab concentrations above the target threshold of 175 μg/mL.The impact of PLEX/PP and IVIg interventions and supplemental ravulizumab dosing on the serum concentration–time profile of ravulizumab is shown in representative examples in Supplementary Figs. S1 and S2, respectively.