Abstract Details

Title Real-World Treatment Outcomes in Patients with Acetylcholine Receptor Antibody-Positive Generalized Myasthenia Gravis Who Transitioned from Efgartigimod to Ravulizumab

Topic Autoimmune Neurology

Presentation(s) P4 - Poster Session 4 (5:00 PM-6:00 PM)

Poster/Presentation
Number 8-003

Objective To describe real-world treatment outcomes in patients with anti-acetylcholine receptor antibody-positive generalized myasthenia gravis (AChR+ gMG) who transitioned from efgartigimod to ravulizumab.

Background While neonatal Fc receptor (FcRn) inhibitors and complement component C5 inhibitor therapies (C5IT) have both demonstrated efficacy in treating AChR+ gMG, real-world data is needed to inform clinical decision-making on how to transition patients between biologic therapies.

Design/Methods This case series report leveraged physician-reported electronic medical records to detail real-world treatment outcomes from four adult patients with AChR+ gMG who transitioned from efgartigimod (FcRn inhibition) to ravulizumab (C5IT). Myasthenia Gravis Activities of Daily Living (MG-ADL) scores and Myasthenia Gravis Foundation of America (MGFA) class were used to assess treatment efficacy. Tapering of concomitant corticosteroid therapy was also assessed.

Results Prior to efgartigimod initiation, median MG-ADL was 12 (range, 10 – 13) and median MGFA class was MGFA IIIa (range, MGFA IIb – IIIa). Median MG-ADL and MGFA class remained unchanged in all patients after three cycles of efgartigimod (median, 21 weeks; range, 20 – 22 weeks). Due to this lack of response, all patients transitioned to ravulizumab. After transitioning to ravulizumab, median MG-ADL improved to 2 (range, 1 – 2) and median MGFA class improved to MGFA I (range, MGFA I – IIa) at final follow-up (median, 98 weeks on ravulizumab; range, 96 – 100 weeks). All patients were on concomitant corticosteroid therapy with efgartigimod (median, 22.5 mg/d; range, 20 – 30 mg/d), but were able to decrease to 10 mg/d or less (median; 8.75 mg/d; range, 5 – 10 mg/d) at final follow-up. All patients remain well-controlled on ravulizumab. One patient was previously unable to work but returned to work full-time after transitioning to ravulizumab.

Conclusions All patients experienced early and sustained improvement upon transitioning from efgartigimod to ravulizumab and were thus able to decrease concomitant corticosteroid use.

Authors/Disclosures
Sonia M. Caraballo-Cartagena, MD (Advocate Health Care) PRESENTER	Dr. Caraballo-Cartagena has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. Dr. Caraballo-Cartagena has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Dr. Caraballo-Cartagena has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Caraballo-Cartagena has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for UCB. Dr. Caraballo-Cartagena has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion. Dr. Caraballo-Cartagena has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Takeda. Dr. Caraballo-Cartagena has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alnylam. Dr. Caraballo-Cartagena has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Argenx.
Raghav Govindarajan, MD, FAAN (HSHS St. Elizabeth Medical Group)	Dr. Govindarajan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MT pharma. Dr. Govindarajan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Govindarajan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Dr. Govindarajan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Catalyst. Dr. Govindarajan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche . Dr. Govindarajan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sarepta. Dr. Govindarajan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amicus. Dr. Govindarajan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. Dr. Govindarajan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion. Dr. Govindarajan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for MT pharma . Dr. Govindarajan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Catalyst. Dr. Govindarajan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Argenx. Dr. Govindarajan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biohaven. Dr. Govindarajan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. Dr. Govindarajan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Takeda. Dr. Govindarajan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Abbvie. The institution of Dr. Govindarajan has received research support from Band of Hope . The institution of Dr. Govindarajan has received research support from Alexion. Dr. Govindarajan has received publishing royalties from a publication relating to health care.

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