Background: Corticosteroids are commonly used for chronic management of gMG but are associated with adverse effects. Furthermore, guidelines recommend steroid-sparing agents when corticosteroids alone are ineffective, contraindicated, or intolerable. Eculizumab and ravulizumab, complement C5 inhibitor therapies (C5ITs), as well as efgartigimod, a neonatal Fc receptor (FcRn) inhibitor, are approved gMG treatments. Here we describe oral corticosteroid (OCS) and nonsteroidal immunosuppressive therapy (NSIST) utilization patterns in patients with gMG treated with C5ITs or an FcRn inhibitor to evaluate steroid sparing with either treatment.
Objective: Assess changes in OCS and NSIST use in patients with gMG receiving C5ITs or an FcRn inhibitor.
Methods: Retrospective analysis of the IQVIA PharMetrics® Plus claims database (1/1/2015-3/31/2024) examined US patients ≥18yrs with: ≥2 claims (≥30 days apart) with MG diagnosis ICD-10 code filed via non-ophthalmologic specialist as primary, continuous insurance enrollment from 6mo before and 12mo after treatment initiation, and continuous treatment (with gap ≤120 days) during 12mo of follow-up. Outcomes included OCS average daily dose (ADD) and percentage of patients with OCS tapering and NSIST claims.
Results: Among the eligible patients, 134 were treated with C5ITs and 45 treated with an FcRn inhibitor; 61.9% and 35.6% had commercial insurance and 25.4% and 44.4% had Medicare, respectively. In the C5IT and FcRn groups, 51.5% and 53.3% were female, mean (SD) age was 51.9 (16.1) and 55.1 (15.9) at first MG claim, with additional mean (SD) 2.0 (1.5) and 2.6 (1.9) yrs until C5IT or FcRn inhibitor initiation, respectively. All patients were receiving OCS at baseline; in the C5IT and FcRn groups, 7% and 4% received ≤5mg/day, which increased to 47% and 40% after 12mo of treatment, respectively. Those receiving >30mg/day decreased from 28% to 7% in the C5IT group and increased from 16% to 22% in the FcRn group. The reduction in mean (SD) ADD was 11.2 (18.0) mg/day and 3.6 (21.0) mg/day for patients treated with C5IT and FcRn inhibitor, respectively (P=0.034). At baseline, 55.2% and 48.9% of patients in the C5IT and FcRn groups had a NSIST claim, which decreased by 28% and 0% in 12mo of follow-up, respectively.
Conclusions: These US medical claims data showed a greater reduction in OCS use after 12mo in patients treated with C5IT compared with those treated with an FcRn inhibitor.