Preoperative Short‐Term Efgartigimod Benefits Myasthenia Gravis Patients Undergoing Thymectomy

Background and Objectives Thymectomy is an effective way to alleviate muscle weakness for myasthenia gravis (MG) patients with and without thymoma. However, thymectomy may exacerbate MG. Efgartigimod as a neonatal Fc receptor (FcRn) blocker has been found to be effective in generalized MG, and this study aims to explore whether application of efgartigimod before surgery can also benefit MG patients who undergo thymectomy. Methods We retrospectively included 140 patients from Shijiazhuang People’s Hospital in this study. Using propensity score matching (PSM) with a 1:3 nearest‐neighbor ratio, 44 patients were selected: 11 were allocated to the efgartigimod group and 33 to the non‐efgartigimod group. Clinical features, quantitative antibody test results, MGFA class at different periods, thymic pathology, operation information, and muscle functional change as evaluated by both MG ADL and QMG scores were collected. Patients were divided into two groups: the efgartigimod group and the nonefgartigimod group. Result Patients who received efgartigimod therapy prior to their operations had a greater decline in MG ADL score (adjusted β coefficient = 5.27 [1.32,9.21], adjusted p = 0.012). After PSM, patients in the efgartigimod group showed lower surgery decision‐to‐finished‐surgery times ( p < 0.001), postoperative therapy time in the ICU ( p = 0.007), better MGFA class after surgery ( p = 0.001), more functional improvement in QMG scores ( p < 0.001), and larger declines in antibody titer ( p < 0.001). Conclusion For MG patients awaiting thymectomy, short‐term efgartigimod serves as an effective bridging therapy. It optimizes patients’ preoperative conditions, potentially shortens the waiting time for surgery as well as postoperative ICU stay and presents a viable alternative to conventional preoperative optimization strategies such as high‐dose prednisolone, plasma exchange, and intravenous immunoglobulin.