Comparing the efficacy of efgartigimod and intravenous immunoglobulin on AQP4‐IgG‐positive neuromyelitis optica spectrum disorder during acute attacks

Aims The aim of our study was to evaluate the efficacy of efgartigimod and intravenous immunoglobulin (IVIG) on AQP4‐IgG‐positive neuromyelitis optica spectrum disorder (NMOSD) patients during acute attacks. Methods A retrospective case–control study was designed to compare the clinical outcomes of 13 NMOSD patients treated with efgartigimod (at a dose of 20 mg/kg in the first and fifth day) and 20 NMOSD patients treated with IVIG (at 0.4 g/kg/day for 5 days). Follow‐up outcome information for patients is documented at 6 months postdischarge. Results Compared with IVIG, efgartigimod could improve NMOSD patients' symptoms during acute attacks, the mean Expanded Disability Status Scale score was significantly improved from 3.0 at admission to 2.5 at discharge ( P < .001). The serum IgG levels were obviously decreased in NMOSD patients treated with efgartigimod ( P < .001). Additionally, AQP4‐IgG titres in 5 NMOSD patients were found to turn negative after efgartigimod treatment. Conclusion The efficacy of efgartigimod is comparable to IVIG therapy in improving acute symptoms of AQP4‐IgG‐positive NMOSD. Efgartigimod could be an elegant alternative to IVIG therapy, and no serious adverse events were observed during infusion.