Myasthenic crisis associated with invasive thymoma successfully treated with ravulizumab: A case series

Myasthenia gravis (MG) can cause life-threatening respiratory failure due to exacerbation known as myasthenic crisis. Thymoma-associated MG (TAMG), accounting for 10-15 % of MG cases, often poses significant therapeutic challenges, particularly with invasive tumors. Ravulizumab, a long-acting complement C5 inhibitor, is effective for generalized MG but has not been studied specifically in TAMG.

To assess the clinical efficacy and safety of ravulizumab in patients with invasive thymoma (Masaoka stage IVa) presenting with myasthenic crisis refractory to conventional therapy.

We retrospectively analyzed clinical data from three patients with TAMG and invasive thymoma who developed myasthenic crises and were treated with ravulizumab.

All patients showed clinical improvement following ravulizumab administration. Two patients experienced rapid symptom resolution, achieving extubation and stabilization. One patient required additional immunotherapy due to incomplete response. No adverse events occurred during follow-up.

Ravulizumab may offer an effective and safe therapeutic option for myasthenic crisis in TAMG patients who respond inadequately to standard therapies, although further studies are necessary.