Clinical and quality-of-life outcomes associated with efgartigimod in patients with generalized myasthenia gravis transitioning from intravenous immunoglobulin.

BACKGROUND

Myasthenia gravis (MG) requires long-term therapeutic strategies that control symptoms while minimizing exposure to oral corticosteroids (OCS). Fast-acting treatments (FT), such as intravenous immunoglobulin (IVIG), are commonly used during exacerbations, whereas efgartigimod (EFG) has recently emerged as an alternative outpatient therapy. This study aimed to compare the efficacy and quality of life (QOL) outcomes of IVIG and EFG in patients with MG.

METHODS

A retrospective analysis was conducted in 67 patients with MG. Fifty-five patients continued IVIG during exacerbations (IVIG group), whereas 12 patients switched from IVIG to EFG (Switched-EFG group). The primary outcome was the achievement of minimal manifestations (MM) or MM with prednisolone ≤ 5 mg/day (MM-5 mg). The secondary outcomes included changes in the Myasthenia Gravis Activities of Daily Living scale (MG-ADL) scores and reduction of prednisolone (PSL) dose between the two groups. The number of hospitalizations and scores on the Japanese version of the Myasthenia Gravis Quality of Life 15-Item Scale-Revised (MG-QOL15r-J) were compared before and after EFG initiation.

RESULTS

No significant differences were observed between the groups in MM, MM-5 mg, ΔMG-ADL, or ΔPSL scores. In the Switched-EFG group, the number of hospitalizations was significantly decreased, whereas the MG-QOL scores improved following EFG initiation. The questionnaire responses consistently favored EFG, particularly in supporting family roles, work participation, and social activities.

CONCLUSION

Notwithstanding the study's limited sample size and observational nature, Switching to EFG yielded notable therapeutic benefits compared with IVIG, while additionally reducing the hospitalization rate and enhancing QOL. Therefore, EFG may be a valuable outpatient treatment option for refractory MG.