Assessment of Hospitalizations in Patients with Generalized Myasthenia Gravis (gMG) Before and During Treatment with Ravulizumab: Results from a Global Registry
Rup Tandan1, Samir Macwan2, James Winkley3, Christopher Scheiner4, Michael Nicolle5, Lida Zeinali6, Chuang Liu6, Gary Cutter7, Ali Habib8, Michael Pulley9
1University of Vermont Medical Center, 2Eisenhower Health Center, 3Baptist Health Medical Group Neurology, 4University of Tennessee Medical Center, 5London Health Sciences Centre, 6Alexion, AstraZeneca Rare Disease, 7University of Alabama at Birmingham, 8University of California, Irvine, 9University of Florida
Objective:
To assess rates and characteristics of hospitalizations among patients with anti-acetylcholine receptor antibody-positive (AChR-Ab+) gMG before and during ravulizumab treatment in clinical practice (MG SPOTLIGHT Registry; NCT04202341).
Background:
Studies comparing healthcare resource utilization in patients with gMG before and after complement component 5 inhibitor therapy (C5IT) are limited.
Design/Methods:
Patients treated with ravulizumab (ravu-only subgroup) or switched from eculizumab to ravulizumab (ecu-to-ravu subgroup) with hospitalization data provided in case report forms were identified from the MG SPOTLIGHT Registry (data cutoff: 7/1/2024). Demographics and hospitalization (admission to ER, ICU, or healthcare facility) rates in the 12 months prior to and/or during ravulizumab treatment were analyzed. Primary reasons for hospitalizations were reported.
Results:
A total of 138 patients (male: 60.1%; White: 85.5%) were assessed; of these, 25/61 patients in the ravu-only subgroup and 42/77 in the ecu-to-ravu subgroup reported ≥1 hospitalization visit. For the ravu-only subgroup, the hospitalization rate decreased from 57.38/100 patient-years (PY) to 15.44/100PY during treatment. For the ecu-to-ravu subgroup, the rate decreased from 27.86/100PY during eculizumab treatment to 21.39/100PY during ravulizumab treatment. Prior to treatment, the primary reasons for visits were myasthenic crisis (ravu-only subgroup, 25.7%; ecu-to-ravu subgroup, 20.5%) or exacerbation (ravu-only subgroup, 45.7%; ecu-to-ravu subgroup, 31.3%); during treatment, most visits were for non-MG related reasons (ravu-only subgroup, 77.8%; ecu-to-ravu subgroup, 64.7%). Among patients with MG-related hospitalizations prior to ravulizumab treatment (n=50), 16 (32.0%) from the ravu-only subgroup and 24 (48.0%) from the ecu-to-ravu subgroup had ≥1 MG crisis or exacerbation. Among patients with MG-related hospitalizations during ravulizumab treatment (n=8), none reported crises or exacerbations.
Conclusions:
These results show hospitalizations and MG crises/exacerbations among patients with gMG are reduced after ravulizumab treatment. Reductions in hospitalizations with ravulizumab were most pronounced in patients not previously treated with eculizumab, whereas the decrease in hospitalizations associated with eculizumab was maintained after switching to ravulizumab.
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