Comparing Long-Term Infection Risk Across Treatments for Generalized Myasthenia Gravis: Svetlana Faktorovich, MD

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"The way that I would maybe apply this is [in clinical practice is] if you have a patient [with generalized MG] that you're seeing and they have some sort of pre-existing increased risk of infection, like recurrent urinary tract infections or chronic sinusitis or bronchitis, then maybe, a complement inhibitor may be a great idea [for the patient]."

Generalized myasthenia gravis (MG), a neuromuscular disorder, is characterized by fluctuating muscle weakness, fatigable weakness of voluntary muscles, and respiratory muscles. This condition has several approved therapeutic options, including complement inhibitors like ravulizumab (Ultomiris; Alexion) and FcRn antagonists like efgartigimod (Vyvgart; argenx) and rozanolixizumab (Rystiggo; UCB), whereas B-cell–depleting agents such as rituximab are commonly used off-label. In a recent study, presented at the 2026 Muscular Dystrophy Association (MDA) Clinical & Scientific Conference, held March 9-11, in Orlando, Florida, researchers compared the real-world infection rates associated with these commonly used treatments for generalized MG.¹

The retrospective longitudinal cohort study used the Veeva Compass claims database from January 2017 to August 2025 to identify patients with MG who initiated ravulizumab, efgartigimod, rozanolixizumab, or rituximab. Researchers defined infection events using diagnosis codes, with duplicate events excluded based on service date, pathogen, and organ system. Among 1515 patients included, findings demonstrated higher infection rates with those treated with efgartigimod and rituximab compared with individuals on ravulizumab, whereas patients treated with rozanolixizumab showed a nonsignificant trend. These data suggested lower observed infection rates with ravulizumab in real-world practice; however, the authors noted that interpretation requires caution due to potential limitations.

To learn more about the clinical implications of the study’s results, NeurologyLive^® spoke with lead author Svetlana Faktorovich, MD, director of neuromuscular medicine at Marcus Neuroscience Institute, a part of Baptist Health South Florida. In the conversation, she highlighted that the analysis adjusted for confounders such as age, comorbidities, concomitant immunosuppressive use, and follow-up duration. Faktorovich emphasized the limitations of real-world data and lack of head-to-head comparisons while also noted that mechanistic differences, particularly the targeted inhibition of the terminal complement pathway, may explain the observed findings and inform individualized treatment decisions.

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REFERENCES
1. Faktorovich S, Phan P, Pandya S, et al. Comparing Longitudinal Treatment-related Adverse Risks of Infection in Generalized Myasthenia Gravis. Presented at: MDA Clinical & Scientific Conference; March 8-11, 2026; Orlando, Florida. Abstract 220.