Background:
Ravulizumab is a potent terminal complement C5 inhibitor. Engineered to have a long half-life that permits a maintenance dosing interval of 8 weeks, ravulizumab is a convenient treatment option.
Objective:
To evaluate the efficacy and safety of ravulizumab in adults with generalized myasthenia gravis (gMG).
Methods:
In this multicenter, double-blind, phase 3 study (NCT03920293), adults with anti-acetylcholine receptor antibody-positive (AChR Ab+) gMG (Myasthenia Gravis Foundation of America Class II–IV) and Myasthenia Gravis Activities of Daily Living (MG-ADL) score ?6 were randomized (1:1) to receive intravenous ravulizumab infusion (body weight-based dose regimen: 2400–3000 mg induction on Day 1, then 3000–3600 mg every 8 weeks beginning on Day 15) or placebo for 26 weeks. Stable-dose acetylcholinesterase inhibitor and immunosuppressant therapy was permitted throughout the study. The primary efficacy endpoint was change from baseline to Week 26 in MG-ADL total score. Secondary endpoints included change from baseline in Quantitative Myasthenia Gravis (QMG) total score.
Results:
In total 175 patients were enrolled from 85 centers worldwide. Treatment with ravulizumab was associated with a statistically significant improvement in MG-ADL total score at Week 26 versus placebo (-3.1 vs -1.4 for placebo; p<0.001). Ravulizumab also demonstrated statistically significant improvements from baseline through Week 26 in QMG total score (p<0.001 vs placebo). Improvements in MG-ADL and QMG scores were observed within 1 week, with maintenance of benefit through Week 26. No notable differences in adverse events were observed between treatment groups.
Conclusions:
Ravulizumab, administered every 8 weeks, provided rapid and sustained improvement in symptoms and was well tolerated in adult patients with AChR Ab+ gMG.