Therapeutic Benefits of Steroid-Sparing Effect From New Myasthenia Gravis Medications: Christopher Scheiner, MD, PhD

WATCH TIME: 5 minutes

"Steroids are good, but they're not great... the best steroids for your patient...is none. These new biologic agents can really bring people back and give them a new lease on life."

Corticosteroids, particularly prednisone, have been a mainstay in the treatment of myasthenia gravis (MG) for several decades. They are primarily used for their immunosuppressive and anti-inflammatory effects, aiming to reduce the production of antibodies that interfere with neuromuscular transmission. As clinicians’ understanding of MG has grown, the therapeutic landscape has begun to expand, with several new novel treatments introduced in the past half decade.

Led by Christopher Scheiner, MD, a retrospective study was conducted to evaluate the long-term corticosteroid use patterns in adult patients with gMG, and corticosteroid dose changes after initiating approved biologics treatments for gMG. Overall, 2237 patients met inclusion criteria comprising 3 treatment cohorts: no biologic (n = 2006); C5 complement inhibition (C5iT; n = 125); and FcRn-A (n = 106). Among the 22.6% (n = 454) of the cohort who started steroid doses at 10 mg, 42.7% of these remained at the same dose after 24 months. Above all, a multivariable analysis showed that patients had an average reduction in annualized total corticosteroid use of 1562 mg (–36%; P = .017) following initiation of C5iT and 668 mg (–21%; P = .08) following initiation of FcRn-a therapy.

These results, presented at the 2024 American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) meeting, held October 15-18, in Savannah, Georgia, highlighted the significant impact new, novel treatments may have on steroid use for patients with MG. Scheiner, a neuromuscular specialist at the University of Tennessee Medical Center, sat down at the meeting to discuss some of the negative downstream effects of long-term steroid use, and how these medications may help. In addition, he discussed ways to optimize and personalize medicine in MG, tailoring treatments based on patient preference and needs. Furthermore, he emphasized the importance of individualized treatment plans, as some patients may do well with minimal therapy, while others may need biologic agents to help with symptom control.

Click here for more coverage of AANEM 2024.

REFERENCE
1. Blackowicz M, Weiskopf E, Clark K, Grant J, Scheiner C. Long-term corticosteroid treatment patterns and steroid-sparing effects of approved treatments for generalized myasthenia gravis in the United States. Presented at: 2024 AANEM Annual Meeting; October 15-18; Savannah, GA. ABSTRACT 145

***CORRECTION: At the 4:00 mark, Dr. Scheiner accidentally states that ravulizumab is infused every 6 months. It is infused 6 times a year, or every 2 months***