{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T17:27:50Z","timestamp":1791912470306,"version":"4.3.4"},"reference-count":46,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Generalized myasthenia gravis (gMG) may progress to life\u2010threatening myasthenic crises (MC) requiring mechanical ventilation. Standard therapy includes intravenous immunoglobulins (IVIg), plasmapheresis (PLEX), immunoadsorption (IA), and high\u2010dose corticosteroids. This study aimed to evaluate the real\u2010world effectiveness of complement\u2010inhibitors (C5\u2010I) in patients refractory to the standard treatment of MC (termed therapy\u2010refractory MC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicentre, retrospective study included patients with acetylcholine\u2010receptor\u2010antibody positive (AChR\u2010ab+) gMG experiencing MC or severe exacerbations (MGFA IVb\/V) treated with eculizumab or ravulizumab in the intensive or intermediate care unit (ICU\/IMC). The primary outcome was the proportion of patients discharged from ICU\/IMC within six weeks after C5\u2010I initiation (German Clinical Trials Registry; DRKS00032104).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 17 identified cases, seven had thymoma\u2010associated MG (TAMG) and 10 had late\u2010onset MG; median age was 77\u2009years. Five patients required non\u2010invasive and 12 invasive ventilation; nine underwent tracheotomy. Therapies included IVIg, PLEX, IA, and corticosteroids. Rituximab was added in two cases. Twelve patients received eculizumab and five ravulizumab. Median hospitalization before C5\u2010I initiation was 32\u2009days (IQR 22\u201350) and median ICU\u2010stay was 17\u2009days (IQR 4.5\u201335) thereafter. Fourteen patients (82%) reached the primary outcome. Two patients died due to bacterial sepsis; no meningococcal infection was observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In MC or severe exacerbations insufficiently responsive to standard treatment with IVIg and PLEX\/IA, add\u2010on C5\u2010I therapy may represent an effective therapeutic approach. Importantly, TAMG, a subtype typically excluded from interventional trials yet often requiring more intensive therapy, also demonstrated clinical improvement. These findings warrant further systematic evaluation of C5\u2010I as adjunctive therapy for AChR\u2010ab+ therapy\u2010refractory MC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ene.70596","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T13:35:51Z","timestamp":1776260151000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Complement Inhibition Therapy in Myasthenic Crisis\u2014A Multicentre Retrospective Analysis of 17 Cases From Germany"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5746-068X","authenticated-orcid":false,"given":"Lea","family":"Gerischer","sequence":"first","affiliation":[{"name":"Department of Neurology With Experimental Neurology Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt\u2010Universit\u00e4t zu Berlin  Berlin 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