Perioperative use of eculizumab in patients with thymoma-associated myasthenia gravis: A preliminary case series of five patients.

Patients with myasthenia gravis (MG) are at risk of myasthenic crisis (MC) or clinical deterioration following thymectomy. Although eculizumab has demonstrated efficacy in the management of MC, its role in perioperative optimization for thymectomy in MG patients has not been systematically evaluated. To assess the efficacy of eculizumab in the perioperative management of thymectomy in MG patients, we included five patients with MG who received perioperative eculizumab treatment during thymectomy. Clinical features and perioperative data were comprehensively analyzed. Outcomes were assessed using the Quantitative Myasthenia Gravis (QMG), MG-Activities of Daily Living (MG-ADL), and Clinical Absolute Scores (CAS). Additionally, we measured acetylcholine receptor antibody (AChR-Ab) levels, total hemolytic complement (CH50), immunoglobulin G (IgG) concentrations, and lymphocyte subset percentages. In this study, from baseline to pre-surgery, all patients except patient 2 and patient 5 exhibited a reduction in QMG and CAS scores; Patients 2 and 5 showed no changes in MG-ADL scores, whereas Patients 1, 3, and 4 all demonstrated clinical improvement with reduced scores. All patients demonstrated decreased CH50 levels, fluctuating AChR-Ab levels and IgG levels. The thymectomy was performed smoothly, and the tracheal tube was removed promptly after surgery. No exacerbation of MG symptoms, postoperative myasthenic crisis (POMC), or serious complications occurred within 7 days post-surgery. In conclusion, these preliminary findings suggest that perioperative eculizumab may provide a feasible strategy for reducing the risk of POMC in MG patients. As a hypothesis-generating case series, further large-scale prospective studies are warranted to confirm these observations.