Health Canada Authorizes PiaSky® (crovalimab for injection) As the First Monthly (Every Four Weeks) Subcutaneous Treatment for People With Paroxysmal Nocturnal Hemoglobinuria (PNH)
- PiaSky® is the first monthly (every four weeks) subcutaneous treatment for PNH in
Canada with the option to self-administer following adequate training(1) - PiaSky® (crovalimab for injection) has the potential to help reduce treatment burden for people with PNH in
Canada and their caregivers (2, 3)
"We are pleased to offer PiaSky as a new option to the treatment landscape for Canadians living with PNH," said
PNH is a rare, genetically acquired, and life-threatening disease of the bone marrow where red blood cells deficient in certain protective markers are destroyed by the complement system, which helps defend against infection.(4) The destruction of these abnormal blood cells lead to symptoms such as anemia, fatigue, hemoglobinuria (blood in the urine), and blood clots.(5, 6) Globally, the estimated prevalence of PNH is estimated at 15.9 cases per million, affecting fewer than 1,000 individuals in
"The approval of crovalimab, a novel C5 inhibitor, provides further freedom of choice for patients with PNH receiving terminal complement blockade," said Dr.
"Monthly (every four weeks) self-injection of crovalimab has the potential to improve the quality of life for people living with PNH," said
About paroxysmal nocturnal hemoglobinuria (PNH)
PNH is a rare hematological disease that may develop on its own or in the context of other bone marrow disorders such as aplastic anemia. Somatic mutations to the PIGA gene lead to clonal expansion of hematopoietic stem cells in the bone marrow which lack certain protein cell surface markers. The absence of these markers renders blood cells susceptible to lysis by the complement system, part of our innate immune defense against common pathogens. These processes cause anemia, thrombosis (blood clots), fatigue, and other debilitating symptoms that significantly impact quality of life and mental health. Individuals can be diagnosed at any stage of life, but are most commonly diagnosed in their 30's or 40's.(5, 6, 11, 12)
About PiaSky ® [crovalimab for injection]
PiaSky is a novel recycling monoclonal antibody that inhibits the complement protein C5 and is designed to block the complement system.(1, 10) It is recycled within the bloodstream, allowing the medicine to bind and inhibit the C5 protein multiple times and to act longer in the body with a small volume of medicine.(1, 13) Individuals will have the option to self-administer PiaSky following an initial intravenous (IV) infusion and weekly subcutaneous (SC) loading doses in the first month of treatment, in appropriate cases following adequate training.(1) PiaSky's flexibility of administration may help to reduce treatment burden and disruption to the lives of people with PNH and their caregivers.(2, 3)
About the COMMODORE 2 study
The COMMODORE 2 study is a Phase III, randomised, open-label study evaluating the efficacy and safety of PiaSky® (crovalimab for injection) versus eculizumab in people with paroxysmal nocturnal hemoglobinuria who have not been treated previously with C5 inhibitors. The study's co-primary efficacy endpoints measure transfusion avoidance and control of hemolysis (the ongoing destruction of red blood cells measured by lactate dehydrogenase levels). The adults enrolled in the study were randomised in a 2:1 ratio to be treated with either subcutaneous (SC) PiaSky every four weeks or intravenous eculizumab every two weeks. The participants who were less than 18 years old were included in a non-randomised treatment arm and were treated with SC PiaSky every four weeks.(9, 10)
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References
- PiaSky Product Monograph,
June 4, 2025 - Roth A, Nishimura JI, Nagy Z,
Gaal-Weisinger J , Panse J, Yoon SS, et al. The complement C5 inhibitor crovalimab in paroxysmal nocturnal hemoglobinuria. Blood. 2020;135(12):912–20. - Sampei Z, Haraya K, Gan SW, Muraoka M, Hayasaka A, Fukuzawa T, et al. Beyond Recycling Antibodies: Crovalimab's Molecular Design Enables Four-Weekly Subcutaneous Injections for PNH Treatment. Int J Mol Sci. 2024;25(21).
- Shah N, Bhatt H. Paroxysmal nocturnal hemoglobinuria. StatPearls.
Treasure Island (FL) 2022. - Schrezenmeier H, Roth A, Araten DJ, Kanakura Y, Larratt L, Shammo JM, et al. Baseline clinical characteristics and disease burden in patients with paroxysmal nocturnal hemoglobinuria (PNH): updated analysis from the International PNH Registry. Ann Hematol. 2020;99(7):1505–14.
- Patriquin CJ, Kiss T, Caplan S, Chin-Yee I, Grewal K, Grossman J, et al. How we treat paroxysmal nocturnal hemoglobinuria: a consensus statement of the Canadian PNH Network and review of the national registry. Eur J Haematol. 2019;102(1):36–52.
- Hill A, Platts PJ, Smith A, Richards SJ, Cullen MJ, Hill QA, et al. The incidence and prevalence of paroxysmal nocturnal hemoglobinuria (PNH) and survival of patients in Yorkshire. Blood. 2006;108:985.
- Hillmen P, Young NS, Schubert J, Brodsky RA, Socie G, Muus P, et al. The complement inhibitor eculizumab in paroxysmal nocturnal hemoglobinuria. N Engl J Med. 2006;355(12):1233–43.
- COMMODORE 2 (NCT04434092). [Internet; cited
June 2025 ] Available at: https://www.clinicaltrials.gov/ct2/show/NCT04434092. - Roth A, He G, Tong H, Lin Z, Wang X, Chai-Adisaksopha C, et al. Phase 3 randomized COMMODORE 2 trial: Crovalimab versus eculizumab in patients with paroxysmal nocturnal hemoglobinuria naive to complement inhibition. Am J Hematol. 2024;99(9):1768-77.
- Oliver MP, C. Paroxysmal Nocturnal Hemoglobinuria: Current Management, Unmet Needs, and Recommendations. J Blood Med. 2023:613-28.
- Parker C, Omine M, Richards S, Nishimura J, Bessler M, Ware R, et al. Diagnosis and management of paroxysmal nocturnal hemoglobinuria. Blood. 2005;106(12):3699–709.
- Fukuzawa T, et al. Long lasting neutralisation of C5 by SKY59, a novel recycling antibody, is a potential therapy for complement-mediated diseases. Sci Rep. 2017;7(1):1080.
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