To describe the early experience of ravulizumab use in acetylcholine receptor antibody-positive generalized myasthenia gravis (AChR+ve gMG).

Ravulizumab was approved for AChR+ve gMG patients. Although ravulizumab and eculizumab have similar mechanisms of action, ravulizumab has a longer half-life and consequently has a lower infusion burden. 

This multicenter retrospective study included AChR+ve gMG patients who were treated with ravulizumab and had both pre- and post-ravulizumab myasthenia gravis activities of daily living (MG-ADL) scores. Clinical information regarding MG history, concomitant treatment(s), MG-ADL, other MG-specific measures, and adverse events were recorded.

A total of 18 patients with mean age of 61.83 (±16.08, n=18) years were included in this cohort. In 10 complement naive patients, a clinically meaningful reduction in mean Mg-ADL (baseline: 6.6 (±3.58) vs 4.4 (±2.28), post ravulizumab) was seen. Six out of 10 patients (60%) had clinically meaningful reduction post ravulizumab and two achieved minimum symptom expression (MSE). In 8 patients switched from eculizumab to ravulizumab, further reduction was noted in post ravulizumab mean Mg-ADL (Baseline: 3.25 (±3.34) vs 1.5 (±2.34) post ravulizumab). None of the patients who switched from eculizumab to ravulizumab experienced worsening symptoms. Eleven out of 14 (78.5%) patients on prednisone therapy were able to reduce their prednisone dose post ravulizumab. None of the patients experienced any major side effects.

In our clinical practice, 60% of AChR+ve gMG complement naive patients experienced a clinically meaningful improvement in MG-ADL scores with ravulizumab. Patients were safely switched from eculizumab to ravulizumab and had further improvement in their mean MG-ADL scores. Of those on prednisone therapy, the majority were able to reduce their prednisone dosage.