OBJECTIVES: Ravulizumab, a terminal complement inhibitor, and efgartigimod, a neonatal Fc receptor blocker, are both approved to treat anti-acetylcholine receptor antibody-positive (AChR-Ab+) generalized myasthenia gravis (gMG); however, their mechanistic and related clinical profiles differ. This analysis compared the dosing schedules and concomitant medication usage in patients receiving ravulizumab or efgartigimod in a real-world setting.

METHODS: This analysis included adult patients with ≥2 MG claims filed by a non-ophthalmologic specialist ≥30 days apart in the IQVIA PharMetrics® Plus database who received ravulizumab or efgartigimod after the MG diagnosis index date and had continuous insurance enrollment 3 months before to 12 months after first dose. Patients who switched treatments after ravulizumab or efgartigimod initiation were excluded. Outcomes included number of doses and concomitant medications. For the efgartigimod group, the number of doses, cycles, and time between cycles were evaluated.

RESULTS: Among the 37 patients who received ravulizumab and 96 who received efgartigimod, 26 (70.3%) and 51 (53.1%) were male, respectively, with mean (SD) age at diagnosis of 62.0 (14.5) and 58.5 (15.2). Mean (SD) infusions received were 7.4 (0.9) with ravulizumab versus 16.9 (8.6) with efgartigimod. The efgartigimod group received 4.2 (2.1) cycles/year on average. In the efgartigimod group, 39 (41%) received ≥5 cycles, and 15 (16%) received only 1 cycle, 40% of which had ≥1 immunoglobulin therapy claim within 1 year of follow-up. Median (interquartile range) time between efgartigimod cycles decreased from 48.0 (35.0-69.5) days between cycles 1&2 to 38.5 (31.0-60.8) days between cycles 3&4. Concomitant therapy use in ravulizumab/efgartigimod groups decreased by 14%/0% for acetylcholinesterase inhibitors, 25%/0% for immunosuppressive therapy, 67%/55% for immunoglobulin therapy, and 20%/8% for steroids.

CONCLUSIONS: Patients receiving ravulizumab had less frequent doses with lower variability and greater decreases in concomitant medication usage than patients receiving efgartigimod. These findings may inform optimal gMG treatment strategies.