Experience with the use of ravulizumab for the treatment of generalized myasthenia gravis: clinical observations

This report presents the experience of using a C5 complement inhibitor in two patients with generalized myasthenia gravis, who tested positive for acetylcholine receptor antibodies, and who presented with a refractory/high-activity course of the disease. A 20-year-old woman with juvenile-onset myasthenia gravis who was refractory to several lines of immunosuppressive therapy demonstrated a positive clinical response to ravulizumab therapy, characterized by an improvement in functional status (a reduction in scores on the daily activity scale) and a reduction in the dose of steroids. The positive effect of treatment has been maintained over a 14-month follow-up period. A 61-year-old man with late-onset myasthenia gravis, multiple comorbidities, and a lack of response to glucocorticoids and azathioprine showed a positive response to treatment with ravulizumab, which has been maintained over a 10-month follow-up period. The paper discusses the heterogeneity of myasthenia gravis, the concept of neuromuscular junction protection, and the advantages of a long-acting inhibitor of the C5 component of the complement system.