Efgartigimod Followed by Telitacicept in Adult Generalized Myasthenia Gravis: A Retrospective Case Series.

BACKGROUND: The emergence of biologics for the treatment of generalized myasthenia gravis (gMG) has increased therapeutic options, but evidence on their flexible use remains limited. PURPOSE: This study retrospectively analyzed gMG patients treated with efgartigimod followed by telitacicept. METHODS: A retrospective analysis was conducted on gMG patients treated with efgartigimod followed by telitacicept. Outcomes included changes in Quantitative Myasthenia Gravis (QMG) and Myasthenia Gravis-Activities of Daily Living (MG-ADL) scores from baseline to weeks 13 and 28, Minimal Manifestation Status (MMS), corticosteroid-sparing potential, safety, and serological markers. RESULTS: Among seven patients included for efficacy evaluation, the baseline QMG and MG-ADL scores were 12.4±4.3 and 7.1±3.6, respectively. These scores decreased by 8.4±3.9 and 5.7±4.2 at week 13 and further decreased by 8.7±3.2 and 6.8±3.4 by week 28 (both P < 0.001). Six patients (86%) achieved Minimal Manifestation Status (MMS), with a median time to achieve MMS being 9 weeks. The average prednisone dosage was significantly reduced from 51.43±14.64 mg at baseline to 5.71±1.89 mg by week 28 (P < 0.05). Common adverse events included mild injection site reactions (n=2) and upper respiratory infections (n=2), with no serious events reported. IgM and IgA levels significantly declined by week 17 (P < 0.05), while BAFF levels increased significantly following telitacicept treatment by week 21 (P < 0.05). CONCLUSION: This regimen demonstrated favorable efficacy and safety, suggesting its potential as an effective option for gMG management.