Case Report: Use of telitacicept for ocular myasthenia gravis

Despite existing treatments of ocular myasthenia gravis (OMG), there remains a need for more effective therapies with fewer side effects. Telitacicept, a novel agent that simultaneously inhibits B lymphocyte stimulator (BLyS) and a proliferation-inducing ligand (APRIL), represents a promising therapeutic candidate for OMG.

In this study, telitacicept monotherapy or combination therapy was administered to three patients with OMG who had shown an inadequate response to, or were intolerant of, standard treatments. All patients demonstrated clinically significant improvement post-treatment. Specifically, both the Myasthenia Gravis Foundation of America-Quantitative Myasthenia Gravis (MGFA-QMG) and the Myasthenia Gravis Activities of Daily Living (MG-ADL) scores showed a marked reduction, indicating decreased disease severity and improved quality of life. Immunological assessments revealed an initial decline in CD19⁺ B lymphocyte counts and acetylcholine receptor (AChR) antibody levels. Interestingly, despite well-controlled clinical symptoms, AChR antibody levels subsequently rebounded and stabilized. Furthermore, pulmonary infections in one patient were not established as causally related to telitacicept.

Telitacicept monotherapy or combination treatment in OMG was associated with favorable clinical improvement and a mild adverse event profile, and its use can be tailored to the individual patient. However, larger-scale and longer-term studies are necessary to confirm these findings and fully establish the role of telitacicept in OMG management.