ORIGINAL RESEARCH article
Front. Neurol.
Sec. Multiple Sclerosis and Neuroimmunology
Add-on Efgartigimod in Myasthenic Crisis: A Promising Treatment Option
Provisionally accepted
Fangyi Shi
Jing Wang
Jiaxin Chen
Rong Lai
Li Feng
Hongyan Zhou
Xunsha Sun
Shen Cun ZhouJiezhen FengXin Huang
Huiyu FengHaiyan Wang*- Sun Yat-sen University, Guangzhou, China
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Background: In myasthenia crisis (MC), plasma exchange (PE) and intravenous immunoglobulin (IVIG) are confirmed effective treatment options, but PE may not be available in time, and the response rate to IVIG is not always satisfactory. This study aimed to investigate whether addition of efgartigimod confers benefits in patients with MC. Methods: This real-world retrospective pilot study examined MC patients admitted to the First Affiliated Hospital of Sun Yat-sen University between August 2023 and May 2024, who were categorized into two groups: the traditional immunotherapy group (n=14) and the add-on efgartigimod group (n=9). In the efgartigimod group, patients received 20 mg/kg efgartigimod（n=9), administered on the first and fifth days . Results：Totally 23 patients were recruited in the study. Total hospital stays, ICU stay, MV duration, intubation time, and non-invasive ventilation time were shorter in the efgartigimod group compared with the traditional immunotherapy group; however, these differences were not statistically significant (p>0.05). We subsequently applied a generalized estimating equation (GEE) to the patients over an 8-week period and observed a reduction in Myasthenia Gravis Activities of Daily Living (MG-ADL) scores in both groups; however, no significant differences were found within the groups (p>0.05). Survival analysis was also conducted, revealing that the addition of efgrtigimod allowed patients to reach the MSE state more quickly, which is statistically significant (p=0.0499). Additionally, three patients with MC who only received high-dose efgartigimod treatment all achieved favorable treatment outcomes. Conclusion：This suggests that efgartigimod may serve as an alternative option for MC patients or as a rescue treatment option for refractory individuals.
Keywords: Myasthenia Gravis, efgartigimod, Myasthenic crisis, Intensive Care Unit, Mechanicalventilation, fast-acting treatment
Received: 01 Sep 2025; Accepted: 30 Nov 2025.
Copyright: © 2025 Shi, Wang, Chen, Lai, Feng, Zhou, Sun, Zhou, Feng, Huang, Feng and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Haiyan Wang
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