[Pubmed] Efgartigimod Versus Lymphoplasmapheresis as Preoperative Rapid Antibody-Clearing Therapies for Thymectomy in Ge

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CNS Neurosci Ther. 2026 Jun;32(6):e70993. doi: 10.1002/cns.70993.

ABSTRACT

AIMS: To compare the real-world effectiveness, surgical and economic outcomes of preoperative rapid antibody clearance therapy (RACT: lymphoplasmapheresis (LPE), efgartigimod (EFG)) versus oral immunosuppressants (Oral IS) in generalized myasthenia gravis (gMG) patients undergoing thymectomy.

METHODS: This retrospective study included 78 patients (36 Oral IS, 42 RACT: 25 LPE, 17 EFG).

PRIMARY OUTCOME: 3-month postoperative quantitative myasthenia gravis (QMG) score.

SECONDARY OUTCOMES: 1-month postoperative exacerbation rate, 3- and 6-month MG activities of daily living (MG-ADL), 6-month QMG, surgical outcomes (operative time, blood loss, postoperative myasthenic crisis (POMC)), perioperative costs (pre- and post-reimbursement). Propensity score overlap weighting balanced covariates. Sensitivity analyses used propensity matching; multiple imputation handled missing data.

RESULTS: After weighting, 3-month QMG scores showed no significant difference between RACT and Oral IS groups (mean difference (MD) -0.23, 95% CI: -2.99 to 2.54, p = 0.831) nor between the EFG and LPE subgroups (MD 1.15, 95% CI: -3.97 to 6.26, p = 0.567); similar for MG-ADL. All groups improved over time (p < 0.001). For EFG vs. LPE, 1-month exacerbation rate was 43.3% vs. 26.1% (p = 0.412). No significant between-group differences between EFG and LPE were found in 6-month QMG/MG-ADL scores and surgical outcomes. EFG had higher preoperative pre-reimbursement costs (MD 14,500 CNY, p = 0.026), but no cost differences remained after insurance. Sensitivity analyses confirmed robustness of the primary findings.

CONCLUSION: Preoperative RACT effectively reduced QMG in gMG patients, with no significant postoperative medium-term effectiveness and safety differences between RACT and Oral IS. Similarly, no significant differences in postoperative medium-term effectiveness, safety, or post-reimbursement costs were observed between EFG and LPE.

PMID:42322065 | DOI:10.1002/cns.70993


Source: https://pubmed.ncbi.nlm.nih.gov/4232206 ... 3&v=2.20.0