Perioperative Administration of Efgartigimod in myasthenia gravis patients with Thymoma: A six-case series

Efgartigimod, an FcRn antagonist for AChR antibody-positive generalized myasthenia gravis (gMG), has not been well explored for thymectomy perioperative management. Compared to conventional IVIg or plasmapheresis, its rapid onset and targeted mechanism may offer certain advantages. This study evaluated Efgartigimod's safety and efficacy in thymectomy for gMG patients with thymoma.

We retrospectively analyzed six gMG patients who underwent thymectomy at the China-Japan Union Hospital of Jilin University between April 2024 and March 2025 after receiving perioperative Efgartigimod therapy. We included five females and one male. Our primary endpoints included alterations in Myasthenia Gravis Activities of Daily Living (MG-ADL) and Quantitative Myasthenia Gravis (QMG) scores, postoperative achievement rate of minimal symptom expression (MSE), incidence of perioperative exacerbation, occurrence of adverse events, and use of corticosteroids.

All patients exhibited clinical improvement following sequential pre- and postoperative administration of Efgartigimod; overall reductions were observed in MG-ADL and QMG scores. After postoperative Efgartigimod therapy, four patients achieved MSE. On the first postoperative day, only one patient experienced a transient perioperative exacerbation, which resolved rapidly post-additional Efgartigimod administration; no myasthenic crisis was reported. No drug-related adverse reactions were observed. However, one patient developed a mild upper respiratory tract infection during the perioperative period, which resolved with symptomatic management.

Perioperative Efgartigimod administration in patients with gMG and thymoma exhibited rapid preoperative symptom improvement, shortened preoperative preparation time, decreased postoperative disease fluctuation, sustained symptomatic relief, and a favorable safety profile. As an emerging targeted immunotherapeutic strategy, Efgartigimod is efficacious in the perioperative management of gMG patients with thymoma, thereby warranting further validation in prospective studies.