OCS are used to treat patients with anti-acetylcholine receptor antibody-positive (AChR-Ab+) gMG. However, high-dose therapy and long-term use—even at lower doses—are associated with substantial systemic adverse effects (AEs). Ravulizumab, a terminal complement component 5 inhibitor approved for AChR-Ab+ gMG, enables reduction and discontinuation of OCS, while maintaining symptom control. Treatment guidelines recommend steroid-sparing strategies, yet clinical practice trends employ prolonged OCS-tapering regimens with higher steroid exposure and risk of associated AEs compared with faster tapering. 

Planned enrollment: ~75 adults with gMG, receiving ravulizumab Q8W and a stable OCS regimen equivalent to a daily average of ≥7.5 mg/day for ≥4 weeks. A tapering schedule based on baseline OCS dose will be assessed. Patients with baseline OCS 7.5-10 mg/day will reduce by 2.5 mg/day Q4W to 2.5 mg/day, then by 1.25 mg/day Q4W until completion. Patients with baseline OCS >10 mg/day will reduce by 5 mg/day Q2W to 10 mg/day, then follow the schedule for those with baseline OCS 7.5-10 mg/day. Primary endpoint is the proportion of patients who discontinue OCS or reduce to ≤5 mg/day (if the reason for no further OCS reduction is suspected adrenal insufficiency) and maintain for ≥4 weeks without gMG clinical deterioration.