BackgroundComplement C5 inhibitors are effective disease-modifying therapies for acetylcholine receptor antibody-positive generalized myasthenia gravis (MG), but cardiovascular safety has not been evaluated as a dedicated outcome domain. With increasing and prolonged use, systematic assessment of cardiovascular and thromboembolic risk - including potential differences between individual C5 inhibitors - is needed.MethodsWe performed a retrospective cohort study using the TriNetX federated electronic health record network, including adults with generalized MG.
Propensity score-matched cohorts compared patients treated with C5 inhibitors with untreated controls (N = 1,094 vs. 1,094), and ravulizumab with eculizumab (N = 330 vs.
330). Outcomes included major adverse cardiovascular events (MACE), thrombotic disorders, acute kidney injury (AKI), arrhythmias, and all-cause mortality over 365 days.
Associations were evaluated using risk ratios (RR) and Cox proportional hazards models.ResultsAfter matching, C5 inhibition was associated with increased risk of AKI (6.1% vs 3.2%, p<0.01; RR 1.70) and thrombotic disorders (5.1% vs 2.6%, p=0.002; RR 1.74) compared to no C5-inhibition treatment. All-cause mortality was significantly lower among C5-treated patients after one year (RR 0.54; p=0.045).
Frontiers in Immunology published a clinical update in Infectious Disease on 14 May 2026.
The item focuses on Complement C5 inhibition in generalized myasthenia gravis is associated with improved survival and increased cardiovascular risk.
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