{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:59:57Z","timestamp":1791568797151,"version":"4.3.4"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T00:00:00Z","timestamp":1742774400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Myasthenia Gravis (MG) is an autoimmune disorder characterized by impaired neuromuscular junction (NMJ) transmission. Current treatments for MG include steroids and nonsteroidal immunosuppressive therapies (NSISTs). However, approximately 20% of patients show a poor response to these therapies, which are often associated with significant side effects. Telitacicept, a novel recombinant fusion protein targeting the BAFF\/APRIL pathway, has shown promise in treating autoimmune diseases, including MG.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study compared the efficacy of telitacicept monotherapy (10 patients) to NSISTs (16 patients) and sequential therapy (6 patients) in managing Myasthenia Gravis (MG) at The First Affiliated Hospital of Wenzhou Medical University (July 2020-November 2024). The primary endpoint was the time to achieve minimal symptom expression (MSE), and secondary endpoint was the change in the mean daily prednisone dosage from baseline to month 4.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among telitacicept-treated patients, 80% achieved MSE within 4 months, with a significant reduction in mean daily dose of prednisone (from 45.00 mg to 6.25 mg, <jats:italic>P<\/jats:italic> &amp;lt; 0.001). In contrast, only 12.5% of the NSISTs group achieved MSE, with no significant change in mean daily dose of prednisone (<jats:italic>P<\/jats:italic> = 0.091). The sequential therapy group (efgartigimod followed by telitacicept) maintained stable disease conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Telitacicept is effective in inducing MSE rapidly and offers a steroid-sparing effect, making it a promising alternative to traditional NSISTs with fewer side effects in MG patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2025.1549034","type":"journal-article","created":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T05:12:54Z","timestamp":1742793174000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Telitacicept as an alternative to non-steroidal immunosuppressive therapies in the treatment of myasthenia gravis: a study on clinical efficacy and steroid-sparing effect"],"prefix":"10.3389","volume":"16","author":[{"given":"Zheyu","family":"Fang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiaoyi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Qu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengli","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bingbing","family":"Wan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiyin","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1038\/s41572-019-0079-y","article-title":"Myasthenia gravis","volume":"5","author":"Gilhus","year":"2019","journal-title":"Nat Rev Dis Primers"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.17305\/bb.2024.11197","article-title":"Mitochondrial dysfunction in myasthenia gravis: Exploring directions for future immunotherapy? A review","volume":"25","author":"Chen","year":"2024","journal-title":"Biomol BioMed"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1550","DOI":"10.3390\/cells13181550","article-title":"Non-coding RNAs in myasthenia gravis: from immune regulation to personalized medicine","volume":"13","author":"Iacomino","year":"2024","journal-title":"Cells"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e179742","DOI":"10.1172\/JCI179742","article-title":"Myasthenia gravis: the future is here","volume":"134","author":"Kaminski","year":"2024","journal-title":"J Clin Invest"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s13760-022-02162-1","article-title":"Minimal symptom expression achievement over time in generalized myasthenia gravis","volume":"123","author":"Uzawa","year":"2023","journal-title":"Acta Neurol Belg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1991","DOI":"10.1007\/s00415-020-09770-y","article-title":"[amp]]lsquo;Minimal symptom expression\u2019 in patients with acetylcholine receptor antibody-positive refractory generalized myasthenia gravis treated with eculizumab","volume":"267","author":"Vissing","year":"2020","journal-title":"J Neurol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"17562864241311128","DOI":"10.1177\/17562864241311127","article-title":"Application of efgartigimod in Chinese patients with myasthenia gravis: a single-center real-world prospective study","volume":"18","author":"Zhu","year":"2025","journal-title":"Ther Adv Neurol Disord"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/mus.27476","article-title":"Utilization of MG-ADL in myasthenia gravis clinical research and care","volume":"65","author":"Muppidi","year":"2022","journal-title":"Muscle Nerve"},{"key":"B9","doi-asserted-by":"publisher","first-page":"17562864241309792","DOI":"10.1177\/17562864241309793","article-title":"Short-term and long-term prognoses in AChR-Ab positive very-late-onset myasthenia gravis patients","volume":"18","author":"Xie","year":"2025","journal-title":"Ther Adv Neurol Disord"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1002\/mus.28334","article-title":"Individualized dosing of efgartigimod in patients with generalized myasthenia gravis: clinical experience at a single center","volume":"71","author":"Silvestri","year":"2025","journal-title":"Muscle Nerve"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2024.1370411","article-title":"Advancements and prospects of novel biologicals for myasthenia gravis: toward personalized treatment based on autoantibody specificities","volume":"15","author":"Ma","year":"2024","journal-title":"Front Pharmacol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e16322","DOI":"10.1111\/ene.16322","article-title":"A multicenter, randomized, open-label, phase 2 clinical study of telitacicept in adult patients with generalized myasthenia gravis","volume":"31","author":"Yin","year":"2024","journal-title":"Eur J Neurol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(21)00159-9","article-title":"Safety, efficacy, and tolerability of efgartigimod in patients with generalised myasthenia gravis (ADAPT): a multicentre, randomised, placebo-controlled, phase 3 trial","volume":"20","author":"Howard","year":"2021","journal-title":"Lancet Neurol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1080\/14728214.2021.1952982","article-title":"Emerging drugs for the treatment of myasthenia gravis","volume":"26","author":"Menon","year":"2021","journal-title":"Expert Opin Emerging Drugs"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1080\/14737175.2023.2207739","article-title":"Conventional and emerging treatments and controversies in myasthenia gravis","volume":"23","author":"Evoli","year":"2023","journal-title":"Expert Rev Neurother"},{"key":"B16","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1186\/s12967-024-05751-1","article-title":"Efficacy and safety of immunosuppressants and monoclonal antibodies in adults with myasthenia gravis: a systematic review and network meta-analysis","volume":"22","author":"Gu","year":"2024","journal-title":"J Transl Med"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-021-01591-1","article-title":"Telitacicept: first approval","volume":"81","author":"Dhillon","year":"2021","journal-title":"Drugs"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1400459","article-title":"Case report: A highly active refractory myasthenia gravis with treatment of telitacicept combined with efgartigimod","volume":"15","author":"Zhang","year":"2024","journal-title":"Front Immunol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1177\/17562864241251476","article-title":"Effectiveness and safety of telitacicept for refractory generalized myasthenia gravis: a retrospective study","volume":"17","author":"Lin","year":"2024","journal-title":"Ther Adv Neurol Diso"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1270011","article-title":"Case Report: Telitacicept in severe myasthenia gravis: a case study with multiple autoantibodies","volume":"14","author":"Guo","year":"2023","journal-title":"Front Immunol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-023-12036-y","article-title":"Refractory generalized myasthenia gravis treated successfully with telitacicept: two cases report","volume":"271","author":"Zhang","year":"2024","journal-title":"J Neurol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1002\/cpdd.1136","article-title":"Pharmacokinetic characteristics, safety, and tolerability of telitacicept, an injectable recombinant human B-lymphocyte stimulating factor receptor-antibody fusion protein, in healthy chinese subjects","volume":"11","author":"Xie","year":"2022","journal-title":"Clin Pharmacol Drug Dev"},{"key":"B23","article-title":"International consensus guidance for management of myasthenia gravis","volume-title":"Neurology","author":"Sanders","year":"2016"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1177\/17562864221080520","article-title":"Factors affecting minimal manifestation status induction in myasthenia gravis","volume":"15","author":"Li","year":"2022","journal-title":"Ther Adv Neurol Disord"},{"key":"B25","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1111\/nyas.13544","article-title":"Rationale for the clinical guidelines for myasthenia gravis in Japan","volume":"1413","author":"Murai","year":"2018","journal-title":"Ann New York Acad Sci"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e16180","DOI":"10.1111\/ene.16180","article-title":"Refocusing generalized myasthenia gravis: Patient burden, disease profiles, and the role of evolving therapy","volume":"31","author":"Sacc\u00e0","year":"2023","journal-title":"Eur J Neurol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.1001\/jamaneurol.2022.2887","article-title":"Efficacy and safety of rituximab for new-onset generalized myasthenia gravis: the RINOMAX randomized clinical trial","volume":"79","author":"Piehl","year":"2022","journal-title":"JAMA Neurol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000005323","article-title":"Randomized study of adjunctive belimumab in participants with generalized myasthenia gravis","volume":"90","author":"Hewett","year":"2018","journal-title":"Neurology"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.04370418","article-title":"Insights into the role of mucosal immunity in igA nephropathy","volume":"13","author":"Zhang","year":"2018","journal-title":"CJASN"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2019.00721","article-title":"The maintenance of memory plasma cells","volume":"10","author":"Khodadadi","year":"2019","journal-title":"Front Immunol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2016060640","article-title":"A randomized, controlled trial of rituximab in igA nephropathy with proteinuria and renal dysfunction","volume":"28","author":"Lafayette","year":"2017","journal-title":"JASN"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaut.2018.10.016","article-title":"The role of APRIL - A proliferation inducing ligand - In autoimmune diseases and expectations from its targeting","volume":"95","author":"Baert","year":"2018","journal-title":"J Autoimmun"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20032000","article-title":"TACI and BAFF-R mediate isotype switching in B cells","volume":"201","author":"Castigli","year":"2005","journal-title":"J Exp Med"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-024-12569-w","article-title":"United States clinical practice experience with eculizumab in myasthenia gravis: symptoms, function, and immunosuppressant therapy use","volume":"271","author":"Habib","year":"2024","journal-title":"J Neurol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1016\/j.ncl.2018.01.011","article-title":"Treatment of myasthenia gravis","volume":"36","author":"Farmakidis","year":"2018","journal-title":"Neurol Clin"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-024-12293-5","article-title":"Real-World experience with efgartigimod in patients with myasthenia gravis","volume":"271","author":"Fuchs","year":"2024","journal-title":"J Neurol"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2023.1284444","article-title":"Long-term safety, tolerability, and efficacy of efgartigimod (ADAPT+): interim results from a phase 3 open-label extension study in participants with generalized myasthenia gravis","volume":"14","author":"Howard","year":"2024","journal-title":"Front Neurol"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurot.2024.e00378","article-title":"Subcutaneous efgartigimod PH20 in generalized myasthenia gravis: A phase 3 randomized noninferiority study (ADAPT-SC) and interim analyses of a long-term open-label extension study (ADAPT-SC+)","volume":"21","author":"Howard","year":"2024","journal-title":"Neurotherapeutics"},{"key":"B39","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1186\/s12883-016-0756-3","article-title":"Response to treatment of myasthenia gravis according to clinical subtype","volume":"16","author":"Akaishi","year":"2016","journal-title":"BMC Neurol"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1549034\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T05:12:58Z","timestamp":1742793178000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1549034\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,24]]},"references-count":39,"alternative-id":["10.3389\/fimmu.2025.1549034"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2025.1549034","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,24]]},"article-number":"1549034"}}