“Introduction: According to GENERATIVE (1) protocol a 69 years old woman affected by Myasthenia Gravis and positive for anti-acetylcholine receptor antibodies and previous Thymoma, received Efgartigimod (EFG), a molecule that inhibits binding between Neonatal Fc receptor (FcRn) and IgG. The patient showed difficulty controlling bulbar symptoms even using Prednisone 50 mg, Pyridostigmine 240 mg, IVg and PLEX at close time points. In August 2023, the patient was hospitalized after a myasthenic relapse with worsening of rhinolalia, dysphagia and ptyalism and inability to feed.

Observation: MG-ADLs scale was measured at each EFG infusion and QMG scale was performed at the first and the last infusion of each cycle. During the first infusion of EFG, the patient had immediate improvement of symptoms: MG-ADLs dropped from 12 to 2. At the end of the first infusion cycle, MG-ADLs was 1, and QMG dropped from 15 to 3. After 28 days of wash-out MG-ADLs was 2 and at the end of the second infusion cycle MG-ADLs was 1. Since November 2023, the patient has performed three medical visits which confirmed MG-ADLs 1, even four months after the last EFG infusion.

Conclusion : The improved outcomes of the patient highlight the importance of Efgartigimod. In previous studies (2), the Bulbar signs, after significant improvement, return almost to the level of pre EFG infusion, after 10 weeks but in this case, led to clinically meaningful improvement in MG-ADL and also a maintenance of its effectiveness of action which exeeds the half-life of circulating IgG in human person.”