Perioperative Administration of Efgartigimod in myasthenia gravis patients with Thymoma: A six-case series.
Efgartigimod may improve perioperative outcomes in gMG patients with thymoma, but further studies are needed to confirm these findings.
Where it sits
this study against the rest of the efpeglenatide corpusSummary and findings
This study evaluated the safety and efficacy of Efgartigimod in six patients with generalized myasthenia gravis (gMG) undergoing thymectomy. Patients received perioperative Efgartigimod therapy and were assessed for changes in Myasthenia Gravis Activities of Daily Living (MG-ADL) and Quantitative Myasthenia Gravis (QMG) scores. Clinical improvements were noted post-treatment, with some patients achieving minimal symptom expression.
Abstract
<h4>Background</h4>Efgartigimod, an FcRn antagonist for AChR antibody-positive generalized myasthenia gravis (gMG), has not been well explored for thymectomy perioperative management. Compared to conventional IVIg or plasmapheresis, its rapid onset and targeted mechanism may offer certain advantages. This study evaluated Efgartigimod's safety and efficacy in thymectomy for gMG patients with thymoma.<h4>Methods</h4>We retrospectively analyzed six gMG patients who underwent thymectomy at the China-Japan Union Hospital of Jilin University between April 2024 and March 2025 after receiving perioperative Efgartigimod therapy. We included five females and one male. Our primary endpoints included alterations in Myasthenia Gravis Activities of Daily Living (MG-ADL) and Quantitative Myasthenia Gravis (QMG) scores, postoperative achievement rate of minimal symptom expression (MSE), incidence of perioperative exacerbation, occurrence of adverse events, and use of corticosteroids.<h4>Results</h4>All patients exhibited clinical improvement following sequential pre- and postoperative administration of Efgartigimod; overall reductions were observed in MG-ADL and QMG scores. After postoperative Efgartigimod therapy, four patients achieved MSE. On the first postoperative day, only one patient experienced a transient perioperative exacerbation, which resolved rapidly post-additional Efgartigimod administration; no myasthenic crisis was reported. No drug-related adverse reactions were observed. However, one patient developed a mild upper respiratory tract infection during the perioperative period, which resolved with symptomatic management.<h4>Conclusion</h4>Perioperative Efgartigimod administration in patients with gMG and thymoma exhibited rapid preoperative symptom improvement, shortened preoperative preparation time, decreased postoperative disease fluctuation, sustained symptomatic relief, and a favorable safety profile. As an emerging targeted immunotherapeutic strategy, Efgartigimod is efficacious in the perioperative management of gMG patients with thymoma, thereby warranting further validation in prospective studies.
Background
This paper addresses the management of generalized myasthenia gravis (gMG) in patients with thymoma undergoing thymectomy, focusing on the use of Efgartigimod, an FcRn antagonist. Previous treatments like IVIg or plasmapheresis have been standard, but Efgartigimod's rapid onset and targeted mechanism may offer advantages. Understanding its safety and efficacy in this context is important for improving perioperative care.
Methods
The study was a retrospective analysis of six gMG patients who underwent thymectomy at the China-Japan Union Hospital of Jilin University between April 2024 and March 2025. The cohort included five females and one male. Primary endpoints included alterations in MG-ADL and QMG scores, postoperative achievement rate of minimal symptom expression (MSE), incidence of perioperative exacerbation, occurrence of adverse events, and use of corticosteroids.
Results
All patients exhibited clinical improvement following sequential pre- and postoperative administration of Efgartigimod. Overall reductions were observed in MG-ADL and QMG scores. After postoperative Efgartigimod therapy, four patients achieved MSE. On the first postoperative day, only one patient experienced a transient perioperative exacerbation, which resolved rapidly post-additional Efgartigimod administration; no myasthenic crisis was reported. No drug-related adverse reactions were observed.
Interpretation
The findings suggest that Efgartigimod may provide clinical benefits in managing gMG during the perioperative period, although the small sample size limits the robustness of these conclusions. The absence of significant adverse effects is notable, but the lack of detailed numeric outcomes makes it difficult to assess the clinical significance of the observed improvements. Further prospective studies are warranted to validate these results.
Key findings
- All patients exhibited clinical improvement following sequential pre- and postoperative administration of Efgartigimod.
- Overall reductions were observed in MG-ADL and QMG scores.
- After postoperative Efgartigimod therapy, four patients achieved minimal symptom expression (MSE).
- On the first postoperative day, only one patient experienced a transient perioperative exacerbation, which resolved rapidly post-additional Efgartigimod administration.
- No myasthenic crisis was reported.
- One patient developed a mild upper respiratory tract infection during the perioperative period, which resolved with symptomatic management.
Limitations
- small n=6 retrospective study
- no control group for comparison
- short follow-up duration
- single-site study
- no detailed numeric outcomes reported