Change in Concomitant Therapies for Generalized Myasthenia Gravis in Patients Receiving Eculizumab: a Retrospective Analysis of Registry Data
Michael Pulley1, Samir Macwan2, Richard Nowak3, Tahseen Mozaffar4, Ema Rodrigues5, Houari Korideck5, Brian Werneburg5, Pushpa Narayanaswami6
1University of Florida, Jacksonville, FL, USA, 2Eisenhower Health, Rancho Mirage, CA, USA, 3Yale School of Medicine, New Haven, CT, USA, 4University of California, IrvineUniversity of California, Irvine, Orange, CA, USA, 5Alexion, AstraZeneca Rare Disease, Boston, MA, USA, 6Beth Israel Deaconess Medical Center/ Harvard Medical School, Boston, MA, USA
Objective:
To assess the use of concomitant therapies at and after eculizumab initiation in patients with generalized myasthenia gravis (gMG) enrolled in a registry.
Background:
Treatment for gMG includes a broad spectrum of therapies, including typical immunosuppressive therapies (ISTs) and eculizumab, a complement C5 inhibitor.
Design/Methods:
Patients enrolled in a US gMG registry that collects data on the use of eculizumab in clinical practice were included if they were treated with eculizumab for ≥ 1 year and had data on concomitant therapy use 12 months prior to eculizumab initiation. Use of azathioprine (AZA), mycophenolate mofetil (MMF), intravenous immunoglobulin (IVIg)/plasma exchange (PLEX), and oral corticosteroids at initiation of, and during eculizumab treatment were analyzed. The data cut-off was July 5, 2022.
Results:
A total of 94 patients were included in the analysis. At eculizumab initiation, 25 (27%), 40 (43%), 25 (27%) and 3 (4%) of patients were receiving zero, one, two, or three of the concomitant therapies investigated, respectively. Nine (10%) patients were on AZA, 26 (28%) on MMF, 19 (20%) on IVIg/PLEX and 47 (50%) on oral corticosteroids. In 57 (61%) patients, the number of concomitant therapies did not change. In 26 (24%) patients, there was a reduction in the number of concomitant therapies. Thirteen (14%) patients needed more treatments after eculizumab initiation. Of the patients using each treatment at eculizumab initiation, 2/9 (22%) patients discontinued AZA, 8/26 (31%) MMF, 5/19 (26%) IVIg/PLEX and 11/47 (23%) oral corticosteroids.
Conclusions:
Approximately one quarter of patients with gMG treated with eculizumab were able to discontinue one or more concomitant therapy. These results from clinical practice in the US provide additional information about the ability to reduce concomitant therapies in patients with gMG on treatment with eculizumab.