Complement inhibitor therapy as a steroid-sparing strategy in generalized myasthenia gravis

Background: Standard management of generalized myasthenia gravis associated with anti-acetylcholine receptor autoantibodies (AChR-gMG) includes corticosteroids and nonsteroidal immunosuppressants. Complement inhibitors (CI) represent a more tailored therapeutic strategy. Real-world data on the steroid-sparing efficacy of CI remain limited. Objective: To investigate the steroid-sparing efficacy of CI in AChR-gMG. Design: We identified 69 AChR-gMG patients on corticosteroids treated with azathioprine (AZA), mycophenolate mofetil (MMF), or CI. Methods: Steroid tapering was assessed by comparing corticosteroid dosage at several time-points to baseline. Results: Steroids reductions were statistically significant for all therapies at every time point compared to baseline (all p < 0.001). Pairwise comparisons using the Mann-Whitney U test revealed significant differences between CI and MMF at 3 months (p = 0.0372), 6 months (p = 0.0193), and 9 months (p = 0.0321) and between CI and AZA at 6 months (p = 0.0415). Conclusion: CI rapidly and effectively reduced corticosteroid dosage in most AChR-gMG patients, suggesting their potential role as steroid-sparing therapeutic options.