The efficacy and safety between efgartigimod and intravenous immunoglobulin in elderly generalized myasthenia gravis patients

The study examines efgartigimod and intravenous immunoglobulin (IVIg) in elderly patients with generalized myasthenia gravis (GMG), focusing on changes in Myasthenia Gravis Activities of Daily Living (MG-ADL) scores, pyridostigmine dosage, and minimal symptom expression (MSE) over an 8-week period. Among 74 enrolled patients, efgartigimod showed greater reduction in MG-ADL scores compared to IVIg at weeks 4 and 8, with no serious adverse events, suggesting its superior efficacy and safety in elderly Chinese patients with acetylcholine receptor antibody-positive (AChR-Ab(+)) GMG. • First comparative study evaluating safety/efficacy of efgartigimod vs IVIg in AChR-Ab(+) generalized myasthenia gravis (gMG), addressing current evidence gaps in therapeutic strategies. • Demonstrates efgartigimod's comparable efficacy to IVIg while highlighting its distinct safety profile, offering alternatives for patients with PE contraindications (e.g., hemodynamic instability) or refractory to conventional therapies. • Mechanistically clarifies that both efgartigimod and IVIg reduce IgG levels, yet efgartigimod's targeted FcRn blockade presents a novel immunomodulatory approach with potential tolerability advantages. • Addresses unmet needs in aging populations: rising MG prevalence in elderly patients lacks dedicated efgartigimod clinical data, emphasizing the urgency for age-specific therapeutic evaluations. • Challenges current paradigms by positioning FcRn inhibitors as precision alternatives to non-selective therapies (PE/IVIg), balancing efficacy with reduced systemic adverse effects.