Understanding Ravulizumab’s Steroid-Sparing Benefits in Generalized Myasthenia Gravis: Katherine Ruzhansky, MD, MS

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"These findings suggest that ravulizumab not only helps control disease activity in myasthenia gravis, but may also enable meaningful reductions in corticosteroid use. That has important implications, because decreasing steroid exposure can reduce treatment burden and potentially minimize long-term complications associated with chronic steroid therapy."

Among patients with generalized myasthenia gravis (gMG), studies have shown that long-term corticosteroid use may be associated with serious adverse effects. In the phase 3 CHAMPION-MG trial (NCT03920293), findings showed that treatment with ravulizumab (Ultomiris; Alexion) demonstrated clinically meaningful efficacy and safety during both the randomized controlled period (RCP) and the open-label extension (OLE). In a post hoc analysis, presented at the 2026 Muscular Dystrophy Association (MDA) Clinical & Scientific Conference, held March 9-11, in Orlando, Florida, researchers analyzed ravulizumab’s steroid-sparing effects in patients receiving concomitant corticosteroids during the OLE.

In the study, patients were randomized 1:1 to ravulizumab or placebo for 26 weeks during the RCP, followed by open-label ravulizumab for up to 4 years. Corticosteroid dose adjustments were permitted at investigator discretion, with changes in Myasthenia Gravis–Activities of Daily Living (MG-ADL) scores and corticosteroid use evaluated from open-label extension baseline to the final assessment. Of 161 patients entering the OLE, 113 received oral corticosteroids (placebo–ravulizumab, n = 64; ravulizumab–ravulizumab, n = 49). All told, results revealed that during the OLE, patients treated with ravulizumab were able to decrease or stop daily corticosteroids and maintain improvements in MG-ADL scores.

To learn about the clinical implications of this post hoc analysis, NeurologyLive^® spoke with lead author Katherine Ruzhansky, MD, MS, director of the Neuromuscular Division at the Medical University of South Carolina. In the conversation, Ruzhansky reported that among patients receiving corticosteroids in the OLE, more than half were able to reduce or discontinue steroid use, with a subset discontinuing entirely. She noted that these dose reductions were associated with sustained or improved MG-ADL scores, suggesting that disease control was maintained. Overall, she explained that the findings support a potential steroid-sparing effect of ravulizumab, which may help reduce treatment burden and long-term risks associated with chronic corticosteroid therapy.

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REFERENCES
1. Ruzhansky K, Pulley MT, Weiskopf E, Sader C, Faktorovich S. Steroid Sparing Impact of Ravulizumab in Adults With Generalized Myasthenia Gravis: Post Hoc Analysis From the Phase 3 CHAMPION MG Trial. Presented at: MDA Clinical & Scientific Conference; March 8-11, 2026; Orlando, Florida. Abstract 216.