How do you decide between FcRn inhibitors and complement inhibitors for treatment-refractory AChR-positive myasthenia gravis?

UPDATE (02/2025):

In the last two years, there have been few real-world comparative efficacy studies published to address this question. I have attached a selection of them below. Overall the conclusion is that equipoise remains- there is no clear evidence of the superiority of complement inhibitors ...

FcRN inhibitors (eg. efgartigimod and rozanolixizumab) and complement inhibitors (eg. ravulizumab , eculizumab, zilucoplan) are both excellent treatment options for refractory AChR (+) MG. Data comparing the two classes of treatments is limited but suggests comparable efficacy. Both are generally we...

In moderately severe or severe symptoms (e.g., usually hospitalized patients), they will usually have trialed IVIG, PLEX, and steroids. If no or very minimal response to PLEX, then I would favor a complement inhibitor for an alternative mechanism of action as opposed to continuing IgG-targeted thera...

When patients are refractory to typical “first line treatments” and are looking for an alternate or adjunct, I usually must devote an entire clinic session to describing the pros and cons of the various treatments for myasthenia gravis. As we are now in a period where there are relatively many optio...