Ultomiris vs. Vyvgart for Myasthenia Gravis: 4 Differences to Consider

Myasthenia gravis (MG) is a rare disorder that causes communication problems between the brain, nerves, and muscles. Symptoms include trouble chewing and smiling, drooping eyelids, and double vision.

We don’t have a cure for MG yet, but there are treatments to help relieve symptoms and improve quality of life. Two biologic medications for adults include Ultomiris (ravulizumab) and Vyvgart (efgartigimod alfa).

Here, we’ll discuss four differences between Ultomiris versus Vyvgart for MG.

1. Ultomiris and Vyvgart work differently to manage myasthenia gravis symptoms

To understand how Ultomiris and Vyvgart work, we first need to look at how MG affects the body.

MG is an autoimmune condition that affects a chemical messenger in the body called acetylcholine (ACh). ACh carries messages from your nerves to your muscles that tell them to move. It works by binding to ACh receptors (binding sites) on muscle cells. 

MG turns your body’s immune system against your ACh receptors. This prevents ACh from sending signals from your nerves and stops your muscles from working the way they should.

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Ultomiris works by blocking a protein called complement C5. This helps prevent your immune system from attacking ACh receptors. It’s not entirely clear how this works for MG, but it seems to help protect the connection between nerves and muscles. In clinical studies, Ultomiris improved MG symptoms significantly better than the placebo (an infusion with no medication in it).

Vyvgart works in a different way to treat MG symptoms. It blocks a receptor called the neonatal Fc receptor (FcRn). FcRn normally helps keep antibodies (immune system proteins that attach ACh receptors) alive longer. Blocking it helps remove them from the body faster, which reduces their impact on your nerves and muscles. Almost 70% of people showed an improvement in their MG symptoms with Vyvgart treatment in clinical studies.

Researchers have not directly compared these two medications, but they’re considered similarly effective at treating MG symptoms overall. However, Vyvgart may start working faster than Ultomiris for some people.

Good to know: Vyvgart and Ultomiris only work for people who test positive for antibodies against ACh receptors. Antibodies are present in about 80% of people living with MG, but not everyone living with MG has them. Your prescriber will likely test for ACh receptor antibodies before deciding whether Ultomiris or Vyvgart are a treatment option for you.

2. Vyvgart has more dosage forms than Ultomiris for myasthenia gravis

Vyvgart comes in two different forms for MG: an infusion into a vein (IV) or an injection under the skin (Vyvgart Hytrulo). Vyvgart Hytrulo contains an additional ingredient (hyaluronidase) that helps the body absorb the medication from under the skin. Healthcare professionals must administer both forms of Vyvgart — you can’t inject them yourself at home. 

The recommended Vyvgart dosage is based on your body weight, and the IV infusion takes about an hour. Vyvgart Hytrulo is given at a fixed dose and takes about a minute to inject. Both forms are considered equally effective for MG.

Ultomiris only comes as an IV infusion at this time. As with Vyvgart, the dosage is based on your body weight and generally takes from 30 to 60 minutes to administer.

Having a dosing option that doesn’t require an hour-long infusion may be an advantage of Vyvgart versus Ultomiris. But you’ll need to receive Vyvgart more often than Ultomiris when you start your treatment — more on that next.

3. Vyvgart and Ultomiris have different dosage schedules

You’ll receive Vyvgart in treatment cycles. Each cycle includes a once-weekly dose for 4 weeks. After your first cycle, you’ll receive treatments as needed based on your symptoms.

With Ultomiris, you’ll receive your first treatment, called a loading dose. Two weeks after your loading dose, you’ll receive your first maintenance dose. After that, you’ll receive one dose of Ultomiris every 8 weeks (2 months).

Ultomiris has a predictable, set dosage schedule. But there’s no set timeline for how often you should receive a cycle of Vyvgart. Instead, your prescriber will determine how often to give Vyvgart based on your symptoms and response to the medication. It’s recommended to wait at least 50 days (about 7 weeks) between treatments.

The set dosing schedule makes Ultomiris a preferred treatment option for some people and their prescribers.

4. Ultomiris has a boxed warning, and Vyvgart doesn’t

Both Vyvgart and Ultomiris can increase the risk of infections while you’re receiving them. That’s because they can weaken your immune system. In most cases, infections are mild, such as urinary tract infections or the common cold. 

But Ultomiris has a boxed warning (the FDA’s most serious medication warning) for serious meningococcal infections. These are infections caused by a certain type of bacteria, and they can be life-threatening. 

To help protect you from this risk, Ultomiris has a Risk Evaluation and Mitigation Strategy (REMS) program. This is an FDA-required medication safety program. Your prescriber will give you a safety card to carry with you and show to any other healthcare professionals you see during and for 8 months after stopping Ultomiris treatment. 

Your prescriber must also verify one of the following before your first treatment:

• You received the meningococcal vaccine at least 2 weeks before starting Ultomiris.

• You are taking 2 weeks of antibiotics to prevent meningococcal infection. (This applies if it’s been less than 2 weeks since you received the vaccine and you need to start Ultomiris right away.)

The risk of meningococcal infection is very low if you’re vaccinated. But it can still happen, and you’ll need treatment right away if it does. Seek emergency care if you develop meningitis symptoms, such as a fever, severe headache, or neck stiffness and pain, while receiving Ultomiris.

How to save on the cost of Ultomiris and Vyvgart

There are ways to save on Vyvgart and Ultomiris, which are only available as brand-name medications. GoodRx can help you navigate your options.

If you have commercial insurance and meet eligibility requirements, the cost of Vyvgart and Vyvgart Hytrulo is as little as $0 using a savings card from the manufacturer.

Ultomiris also has a copay program that can help you save if you have commercial insurance. It covers up to $15,000 of out-of-pocket expenses per year.

Good to know: Vyvgart and Ultomiris are administered in a healthcare setting. So they’re not prescriptions you’ll pick up at your local pharmacy. And in some cases, they may be covered by your medical insurance plan instead of your pharmacy insurance plan. Your prescriber’s office can help you determine the best way to access these medications and apply any available savings.

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Written by:

ThienLy Neal, PharmD

ThienLy Neal, PharmD, has over 10 years experience in the pharmacy field, including in such settings as retail, hospital, compounding, and managed care. She has led various clinical programs while focusing on medication adherence programs, specialty drug initiatives, and polypharmacy safety initiatives.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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