ZHANG Xiaohe 1 , ZHANG Hao 2 , TANG Ping 2 , LI Jiaduo 1 , XUE Yinping 1 , ZHANG Xiaojing 1 , QI Guoyan 1,3
  • 1. Myasthenia Gravis Diagnosis and Treatment Center, Shijiazhuang First People’s Hospital, Shijiazhuang, 050000, P. R. China;
  • 2. Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300041, P. R. China;
  • 3. Hebei Key Laboratory of Myasthenia Gravis Research and Hebei Clinical Research Center for Myasthenia Gravis, Shijiazhuang, 050000, P. R. China;
QI Guoyan, Email: srm_qgy@163.com
Myasthenia gravis; neuromuscular junction diseases; efgartigimod; FcRn antagonist; thymectomy; immunological parameters; postoperative recovery
10.7507/1007-4848.202601073
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Objective  To assess the clinical value of efgartigimod as a rapid induction therapy in the perioperative management of patients with myasthenia gravis (MG) undergoing thymectomy. Methods  This retrospective study collected data from MG patients who underwent thymectomy at Myasthenia Gravis Diagnosis and Treatment Center, Shijiazhuang First People’s Hospital between October 2023 and July 2024. Patients were categorized into an efgartigimod group and a control group based on whether they received efgartigimod prior to thymectomy. Data collected included patient demographics (age at onset, sex), thymic pathology, preoperative immunosuppressant use, Myasthenia Gravis Foundation of America (MGFA) classification at 3 days pre- and 1 week post-surgery, postoperative complications, quantitative myasthenia gravis (QMG) scores, antibody titers, total IgG titers, and CD19+ B cell percentages. Hypothesis testing and multiple linear regression models were employed to analyze whether preoperative efgartigimod improved patient recovery. Results  A total of 57 patients were included (16 males, 41 females), with a median age of 50 (35, 65) years, consistent with the typical MG demographic. Preoperative efgartigimod use was associated with a 38.0% reduction in postoperative QMG scores [adjusted β regression coefficient=0.38 (0.16, 0.60), adjusted P=0.001] and an increased likelihood of improvement in postoperative MGFA classification [adjusted OR=–1.98 (–3.08, –0.89), adjusted P<0.001]. Regarding immunological markers, preoperative efgartigimod was associated with significant reductions in postoperative total IgG levels [adjusted β regression coefficient=0.42 (0.30, 0.53), adjusted P<0.001] and antibody titers [adjusted β regression coefficient=0.27 (0.16, 0.38), adjusted P<0.001]. However, it had no significant effect on the proportion of CD19+ B cells [adjusted β regression coefficient=–1.37 (–3.26, 0.53), adjusted P=0.151]. Conclusion  For MG patients undergoing thymectomy, preoperative efgartigimod treatment can significantly accelerate postoperative recovery and reduce postoperative total IgG and MG-related antibody levels.

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