To describe the baseline characteristics, treatment and safety outcomes of the patients with acetylcholine receptor-positive (AChR+) generalized myasthenia gravis (gMG) treated with eculizumab and/or rituximab in our clinic.

Rituximab and eculizumab are considered as treatment options for refractory MG, but comparative clinical data which is derived from real world experience is still limited.

Both groups were comparable in terms of clinical, demographic characteristics, age of onset, disease duration and presence of thymoma. Eculizumab was associated with a statistically significant better outcome compared with rituximab, as measured by the decrease of the MGADL score at 1, 3th, 6^th and 12 months of treatment, steroid sparing effect after a year of treatment (mean decrease of prednisolone -21.8mg±13.5 vs -6.6mg±9.4), the need of rescue treatment (IVIG) and myasthenic crisis during the treatment (p<0.001) with similar safety profile. Six had received rituximab prior to eculizumab at least a for a year without sufficient symptom control (MG-ADL ≥9), all of them achieved MM status at the 3th month of eculizumab treatment and maintained MM at the 12^th month.

Out data provides real-world evidence supporting the use of eculizumab over rituximab for the treatment of refractory, anti-AChR-ab positive MG, as eculizumab led to rapid and sustained achievement of MM.