Complement component C5 iRNA compositions and methods of use thereof

1. A method of inhibiting complement component C5 expression in a cell, the method comprising:

contacting the cell with a double stranded ribonucleic acid (dsRNA) agent that inhibits expression of a complement component C5 gene, wherein the dsRNA agent comprises a sense strand and an antisense strand forming a double stranded region 15-30 nucleotide pairs in length, the antisense strand comprising a region of complementarity which comprises at least 15 contiguous nucleotides differing by no more than 3 nucleotides from nucleotides 769-821 of SEQ ID NO:1; and

contacting the cell with an anti-complement component C5 antibody, or antigen-binding fragment thereof,

thereby inhibiting expression of the complement component C5 gene in the cell.

2. The method of claim 1 , wherein the cell is within a subject.

3. The method of claim 2 , wherein the subject is a human.

4. The method of claim 3 , wherein the human subject has a disease or disorder that would benefit from reduction in complement component C5 expression.

5. The method of claim 4 , wherein the disorder is a complement component C5-associated disease.

6. The method of claim 4 , wherein the dsRNA agent is administered to the subject before the anti-complement component C5 antibody, or antigen-binding fragment thereof, is administered to the subject.

7. The method of claim 6 , wherein the dsRNA agent is administered to the subject first for a period of time sufficient to reduce the levels of complement component C5 in the subject.

8. The method of claim 1 , wherein the antibody is eculizumab.

9. The method of claim 8 , wherein the complement component C5 expression is decreased for an extended duration.

10. The method of claim 5 , wherein the complement component C5-associated disease is selected from the group consisting of paroxysmal nocturnal hemoglobinuria (PNH); atypical hemolytic uremic syndrome (aHUS); neuromyelitis optica (NMO); multiple sclerosis (MS); myasthenia gravis; and membranous nephropathy.

11. The method of claim 10 , wherein the complement component C5-associated disease is paroxysmal nocturnal hemoglobinuria (PNH).

12. The method of claim 10 , wherein the complement component C5-associated disease is atypical hemolytic uremic syndrome (aHUS).

13. The method of claim 2 , wherein C5 levels in a tissue or a fluid of the subject are reduced by at least 10%.

14. The method of claim 1 , wherein the dsRNA agent comprises at least one modified nucleotide.

15. The method of claim 1 , wherein at least one strand of the dsRNA agent comprises a 3′ overhang of at least 1 nucleotide.

16. The method of claim 1 , wherein the dsRNA agent further comprises a ligand.

17. The method of claim 1 , wherein the dsRNA agent further comprises at least one phosphorothioate or methylphosphonate internucleotide linkage.

18. The method of claim 1 , wherein the antisense strand comprises a region of complementarity which comprises at least 17 contiguous nucleotides differing by no more than 3 nucleotides from the nucleotide sequence of 5′-UAUUAUAAAAAUAUCUUGCUUUU-3′ (SEQ ID NO:113), and wherein the dsRNA agent comprises at least one modified nucleotide.

19. The method of claim 1 , wherein the agent comprises a sense strand comprising the nucleotide sequence of 5′-AAGCAAGAUAUUUUUAUAAUA-3′ (SEQ ID NO:62), and an antisense strand comprising the nucleotide sequence of 5′-UAUUAUAAAAAUAUCUUGCUUUU-3′ (SEQ ID NO:113).

20. The method of claim 19 , wherein the sense strand comprises 5′-asasGfcAfaGfaUfAfUfuUfuuAfuAfaua-3′ (SEQ ID NO:2876) and the antisense strand comprises 5′-usAfsUfuAfuaAfaAfauaUfcUfuGfcuususudTdT-3′ (SEQ ID NO:2889),

wherein a, g, c and u are 2′-O-methyl (2′-OMe) A, G, C, and U, respectively; Af, Gf, Cf and Uf are 2′-fluoro A, G, C and U, respectively; dT is a deoxy-thymine nucleotide; and s is a phosphorothioate linkage.

21. A method of treating a subject having a disease or disorder that would benefit from reduction in complement component C5 expression, the method comprising

administering to the subject a therapeutically effective amount of a double stranded ribonucleic acid (dsRNA) agent that inhibits expression of a complement component C5 gene, wherein the dsRNA agent comprises a sense strand and an antisense strand forming a double stranded region 15-30 nucleotide pairs in length, the antisense strand comprising a region of complementarity which comprises at least 15 contiguous nucleotides differing by no more than 3 nucleotides from nucleotides 769-821 of SEQ ID NO:1; and

administering to the subject a therapeutically effective amount of an anti-complement component C5 antibody, or antigen-binding fragment thereof,

thereby treating the subject.

22. The method of claim 21 , wherein the antibody is eculizumab.

23. A method of preventing at least one symptom in a subject having a disease or disorder that would benefit from reduction in complement component C5 expression, the method comprising

administering to the subject a prophylactically effective amount of a double stranded ribonucleic acid (dsRNA) agent that inhibits expression of a complement component C5 gene, wherein the dsRNA agent comprises a sense strand and an antisense strand forming a double stranded region 15-30 nucleotide pairs in length, the antisense strand comprising a region of complementarity which comprises at least 15 contiguous nucleotides differing by no more than 3 nucleotides from nucleotides 769-821 of SEQ ID NO:1; and

administering to the subject a prophylactically effective amount of an anti-complement component C5 antibody, or antigen-binding fragment thereof,

thereby preventing at least one symptom in the subject having a disorder that would benefit from reduction in C5 expression.

24. The method of claim 1 , wherein the region of complementarity comprises at least 15 contiguous nucleotides differing by no more than 3 nucleotides from nucleotides 780-802 of SEQ ID NO:1.

25. A method of inhibiting complement component C5 expression in a cell, the method comprising:

contacting the cell with a double stranded ribonucleic acid (dsRNA) agent that inhibits expression of a complement component C5 gene, wherein the dsRNA agent comprises a sense strand and an antisense strand forming a double stranded region 15-30 nucleotide pairs in length, the antisense strand comprising a region of complementarity which comprises at least 15 contiguous nucleotides differing by no more than 3 nucleotides from nucleotides 780-802 of SEQ ID NO:1; and

contacting the cell with an anti-complement component C5 antibody, or antigen-binding fragment thereof,

thereby inhibiting expression of the complement component C5 gene in the cell.

26. The method of claim 25 , wherein the cell is within a human subject.

27. The method of claim 26 , wherein the antisense strand comprises a region of complementarity which comprises at least 17 contiguous nucleotides differing by no more than 3 nucleotides from the nucleotide sequence of 5′-UAUUAUAAAAAUAUCUUGCUUUU-3′ (SEQ ID NO:113), and wherein the dsRNA agent comprises at least one modified nucleotide.

28. The method of claim 22 , wherein the effective amount of eculizumab to treat the subject is reduced as compared to the effective amount of eculizumab required to treat the subject in the absence of administration of the effective amount of the dsRNA agent.

29. The method of claim 28 , wherein eculizumab is administered to the subject at a dose of less than about 600 mg.

30. The method of claim 29 , wherein the dsRNA agent is administered to the subject at a dose of about 0.5 mg/kg to about 50 mg/kg.

31. The method of claim 28 , wherein eculizumab is administered to the subject at a dose of about 100-500 mg.

32. The method of claim 31 , wherein the dsRNA agent is administered to the subject at a dose of about 0.5 mg/kg to about 50 mg/kg.