Presentation (CTI)

OBJECTIVES: A range of anti-C5 and anti-FcRn drugs have been launched to treat myasthenia gravis. Some are indicated for several pathologies, while others are specific to this disease. They aren’t included in good practice guidelines, and there are no direct comparative clinical data between them. This situation has led to heterogeneity in the use of these treatments by clinicians, who tend to use anti-C5s for background treatment and anti-FcRns for crisis management. This study analyzes prescribing data for these drugs to assess their use and market share in the AP-HP.
METHODS: Prescription data by indication for drugs were extracted from the AP-HP database for the period 2021-2024. They were analyzed according to cost (€) and quantity expressed in defined daily doses (DDD). For drugs without DDDs, such as efgartigimod and zilucoplan, an estimate was made based on the average number of cycles administered during clinical trials.
RESULTS: Myasthenia prescriptions of eculizumab (reference drug) increase from 853 DDD in 2020 to 6066 DDD in 2022. This falls to 352 DDD in 2023 with the arrival of ravulizumab, then goes to 1861 DDD in 2024 despite the eculizumab biosimilar. Ravulizumab prescriptions rise from 214 DDD in 2022 to 12095 DDD in 2024. Efgartigimod-IV increases from 5077 DDD in 2023 to 25108 DDD in 2024, while zilucoplan has a more modest prescription of 158 DDD. In 2024, ravulizumab accounted for 57% of myasthenia-related costs (€9,900,993), followed by efgartigimod-IV at 37% (€6,386,818), eculizumab at 5% (€906,179) and zilucoplan at 1% (€89,809).
CONCLUSIONS: Prescriptions are tending towards efgartigimod-IV, though ravulizumab continues to hold an important place, particularly in long-stay patients, where it replaces eculizumab and generates the highest costs. However, this trend could change with the arrival of subcutaneous forms available in community pharmacies (zilucoplan, efgartigimod-SC and rozanolixizumab), potentially modifying therapeutic practices and hospital costs.