Efgartigimod Versus Lymphoplasmapheresis as Preoperative Rapid Antibody‐Clearing Therapies for Thymectomy in Generalized Myasthenia Gravis: Effectiveness, Safety and Cost Outcomes Compared to Conventional Preparation

Abstract

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. cns70993-sec-0001 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. cns70993-sec-0002 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,= 0.831) nor between the EFG and LPE subgroups (MD 1.15, 95% CI: −3.97 to 6.26,= 0.567); similar for MG‐ADL. All groups improved over time (< 0.001). For EFG vs. LPE, 1‐month exacerbation rate was 43.3% vs. 26.1% (= 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,= 0.026), but no cost differences remained after insurance. Sensitivity analyses confirmed robustness of the primary findings. cns70993-sec-0003 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. cns70993-sec-0004 In this exploratory study, no statistically significant differences in effectiveness, safety, or cost were observed between EFG and LPE, nor between RACT and oral immunosuppressants for pre‐thymectomy preparation in MG. These findings are hypothesis‐generating and warrant prospective validation. graphical