Treatment patterns of oral corticosteroid and nonsteroidal immunosuppressant therapy and clinical outcomes in US patients receiving ravulizumab or eculizumab for generalized myasthenia gravis.

A growing body of evidence supports a meaningful immunosuppressive therapy (IST)-sparing role for the complement component 5 inhibition therapies (C5ITs) ravulizumab and eculizumab in the treatment of generalized myasthenia gravis (gMG). However, a comprehensive understanding of long-term concomitant IST use patterns and clinical outcomes among patients receiving these C5ITs is needed. This retrospective cohort study assessed oral corticosteroid use, nonsteroidal immunosuppressant therapy (NSIST) use, and clinical outcomes among US adults with gMG (identified from January 2015 to March 2024) via the IQVIA PharMetrics® Plus Closed Health Plan claims database. Eligible patients with gMG were treated continuously with ravulizumab or eculizumab over an 18-month period. Oral corticosteroid use and average daily dose (ADD) together with NSIST use were evaluated at baseline and throughout the study period. The incidence of hospitalizations for MG exacerbations or MG crises was assessed among all patients. Overall, 242 ravulizumab- or eculizumab-treated patients were included. From baseline (3-month period before C5IT initiation) to end of follow-up (15 to 18 months after C5IT initiation), mean oral corticosteroid ADDs were reduced by 59.8% (16.9 to 6.8 mg; P < 0.01 [n = 121]). The number of patients using an NSIST significantly decreased from 75 at baseline to 55 by the end of follow-up (-27%; P = 0.005). Significant per-patient decreases in MG-related hospitalizations (66.2% [P < 0.01]) and MG crises (70.5% [P = 0.015]) were observed from baseline to end of follow-up in this cohort (N = 242). Ravulizumab and eculizumab were associated with reduced IST use and lower incidence of MG-related hospitalizations among patients with gMG.