Complement Inhibitors in Myasthenia Gravis


Dr Neelam Gupta highlights differences between recently approved complement inhibitors for treatment of myasthenia gravis.

This is a video synopsis of a discussion involving Neelam Goyal, MD, shedding light on complement inhibitors in the treatment landscape of myasthenia gravis (MG). Dr. Goyal begins by tracing the evolution of MG medications, noting the approval of eculizumab in 2017, ravulizumab in 2022, and the recent approval of zilucoplan. All three are complement inhibitors designed for AChR (acetylcholine receptor) antibody-positive generalized myasthenia gravis, each with distinct characteristics.

Eculizumab, the first-in-class medication, was studied in refractory MG patients every two weeks, while ravulizumab, a second-generation complement inhibitor, offers the convenience of an eight-week dosing interval. Zilucoplan stands out as a macrocyclic peptide, administered subcutaneously daily.

Addressing safety concerns, Dr. Goyal emphasizes the importance of vaccination against meningococcal infections before initiating complement inhibitors due to the vital role of the complement system in fighting bacteria. Additionally, enrollment in a REMS (Risk Evaluation and Mitigation Strategy) program is necessary.

Comparing the efficacy of these complement inhibitors, Dr. Goyal acknowledges challenges due to the absence of head-to-head comparisons. Eculizumab, despite being studied in refractory patients, remains a noteworthy option. Ravulizumab, with an extended dosing interval and efficacy in non-refractory patients, is considered a favorable alternative. Zilucoplan, a subcutaneous daily peptide, offers a unique option with its own set of considerations.

Dr. Goyal concludes by expressing the excitement within the MG specialist community due to the plethora of therapeutic options. However, she highlights persisting challenges in addressing unmet needs, especially in ocular, seronegative, and pregnant MG patient populations. As a clinician, she encourages colleagues to consider MG in patients with relevant symptoms and suggests collaboration with MG specialists for complex cases. In the era of evolving treatments, Dr. Goyal underscores the significance of timely referrals and collaborative efforts in managing MG effectively.

Video synopsis is AI-generated and reviewed by NeurologyLive® editorial staff.

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