To describe changes in concomitant immunosuppressive therapy (con-IST) use after ravulizumab initiation among patients with generalized myasthenia gravis (gMG) in the global MG SPOTLIGHT Registry.

High-dose and long-term use of con-ISTs such as oral corticosteroids (OCS) are associated with short- and long-term adverse effects. The global MG SPOTLIGHT Registry (NCT04202341) assesses clinical practice outcomes with ravulizumab and eculizumab in adults with anti-acetylcholine receptor antibody-positive (AChR-Ab+) gMG.

This analysis included patients treated with ravulizumab for ≥6 months with available con-IST (azathioprine, mycophenolate mofetil, intravenous immunoglobulin/plasma exchange, methotrexate, and OCS) data. Descriptive analyses characterized treatment changes after ravulizumab initiation. No adjustment for covariates was performed. Safety was assessed in all patients.

As of July 1, 2024, 44 patients fulfilled inclusion criteria for analysis (male: 70.5%; mean±SD age at enrollment: 68.3±13.0 years; mean±SD ravulizumab treatment duration: 1.3±0.8 years). At ravulizumab initiation, 19/44 (43.2%), 13/44 (29.5%), and 1/44 (2.3%) patients were receiving 1, 2, and ≥3 con-ISTs, respectively. Thereafter, 10/33 (30.3%) patients discontinued ≥1 con-IST, with 3/10 (30%) and 8/10 (80%) patients discontinuing within 3 months and 6 months of ravulizumab initiation, respectively. Following ravulizumab treatment, the number of patients receiving ≤5 and ≤10 mg/day OCS increased from 11/26 (42.3%) and 16/26 (61.5%), respectively, to 14/26 (53.8%) and 20/26 (76.9%) 3 months after ravulizumab initiation, and 16/26 (61.5%) and 20/26 (76.9%) 6 months after ravulizumab initiation. Ravulizumab was well tolerated, consistent with previous analyses and clinical trial data. Results with extended follow-up will be presented.

Reduced con-IST and OCS burden was observed in patients with AChR-Ab+ gMG treated with ravulizumab in clinical practice, supporting a steroid-sparing role for ravulizumab.