{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T22:50:51Z","timestamp":1794091851152,"version":"4.8.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T00:00:00Z","timestamp":1762387200000},"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>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Target-specific immunotherapies have been shown to effectively treat myasthenia gravis (MG) with less side effects. One such immunotherapy is efgartigimod, a neonatal Fc receptor antagonist, promotes degradation of pathogenic IgG antibodies. However, data specifically focusing on elderly, especially for those over 80 years, remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study included generalized MG patients over 80 years old from four neuromuscular centers who were treated with efgartigimod. Data regarding MG history, treatment regimens, and scores from the MG-ADL, QMG, and MGC scales, as well as adverse events, were prospectively recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twelve patients with mean age of 82.9 \u00b1 2.5 years were included. Anti-AChR antibodies were positive in 11 patients and anti-MuSK antibodies were detected in 1 patient. All patients received at least one cycle of efgartigimod treatment, for the following indications: myasthenia gravis acute exacerbation (MGAE, n=8), mild\/moderate disease (n=3), and myasthenic crisis (MC, n=1). At week 4 (1week after the final infusion), the study showed significant reductions in all efficacy measurements: MG-ADL scores decreased by 52.2% \u00b1 30.8% (from 10.9 \u00b1 2.7 to 3.6 \u00b1 2.1), QMG scores by 36.6% \u00b1 28.4% (from 18.2 \u00b1 7.0 to 11.7 \u00b1 8.3), MGC scores by 48.2% \u00b1 33.4% (from 17.8 \u00b1 7.5 to 9.0 \u00b1 8.6). The greatest improvement was observed in the MGAE subgroup, with reductions of 69.8% \u00b1 16.9% in MG-ADL, 51.8% \u00b1 20.6% in QMG, 66.5% \u00b1 20.2% in MGC. Clinically meaningful improvement (CMI) was rapidly achieved by 91.7% (11\/12) of patients at 1.3 \u00b1 0.5 weeks, with 8.3% (1\/12) reaching minimal symptom expression (MSE) by week 4. However, two patients in the mild\/moderate group failed to sustain CMI through week 4, resulting in nine responders overall (8 MGAE, 1mild\/moderate). These responders maintained symptom control throughout the 24-week follow-up with subsequent therapies. Treatment-related adverse events were mild: two patients experienced transient minor headache and one patient had mild upper respiratory tract infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This multicenter study demonstrated that efgartigimod was efficacious and safe in the elderly MG over 80 years of age. Elderly patients with MGAE presented to benefit the most from efgartigimod treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2025.1685233","type":"journal-article","created":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T11:46:10Z","timestamp":1762429570000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Efgartigimod for generalized myasthenia gravis in the extreme elderly (\u226580 years): a multicenter retrospective real-world study"],"prefix":"10.3389","volume":"16","author":[{"given":"Ye","family":"Hong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang-Wen","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping-Ping","family":"Kong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shi-Qi","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui-Yuan","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen-Hua","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong-Dong","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teng","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian-Quan","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,6]]},"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":"10.1016\/S1474-4422(21)00357-4","article-title":"Advances in the understanding of disease mechanisms of autoimmune neuromuscular junction disorders","volume":"21","author":"Huijbers","year":"2022","journal-title":"Lancet Neurol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000008903","article-title":"Clinical and therapeutic features of myasthenia gravis in adults based on age at onset","volume":"94","author":"Cort\u00e9s-Vicente","year":"2020","journal-title":"Neurology"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000210139","article-title":"Changes in myasthenia gravis incidence in Denmark from 1985 to 2021:A Nationwide Population-Based Study","volume":"104","author":"Nielsen","year":"2024","journal-title":"Neurology"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmd.2023.02.013","article-title":"Clinical characteristics and prognosis of very late-onset myasthenia gravis in China","volume":"33","author":"Tang","year":"2023","journal-title":"Neuromuscular disorders: NMD"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000210005","article-title":"Epidemiologic study of myasthenia gravis in the elderly US population: A longitudinal analysis of the medicare claims database, 2006-2019","volume":"103","author":"Bruckman","year":"2024","journal-title":"Neurology"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002790","article-title":"International consensus guidance for management of myasthenia gravis: Executive summary","volume":"87","author":"Sanders","year":"2016","journal-title":"Neurology"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12974-022-02448-4","article-title":"Independent risk factors for myasthenic crisis and disease exacerbation in a retrospective cohort of myasthenia gravis patients","volume":"19","author":"Nelke","year":"2022","journal-title":"J Neuroinflamm"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-023-11925-6","article-title":"Myasthenia gravis treatment in the elderly presents with a significant iatrogenic risk: a multicentric retrospective study","volume":"270","author":"Chanson","year":"2023","journal-title":"J Neurol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1046\/j.1468-1331.2002.00352.x","article-title":"Thymectomy and anti-muscle autoantibodies in late-onset myasthenia gravis","volume":"9","author":"Romi","year":"2002","journal-title":"Eur J Neurol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1196\/annals.1405.040","article-title":"Myasthenia gravis in the elderly: Is it different","volume":"1132","author":"Aarli","year":"2008","journal-title":"Ann New York Acad Sci"},{"key":"B12","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":"B13","doi-asserted-by":"publisher","DOI":"10.1212\/CPJ.0000000000200276","article-title":"Therapeutic responses to efgartigimod for generalized myasthenia gravis in Japan","volume":"14","author":"Suzuki","year":"2024","journal-title":"Neurol Clin Pract"},{"key":"B14","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":"B15","doi-asserted-by":"publisher","first-page":"578431","DOI":"10.1016\/j.jneuroim.2024.578431","article-title":"Efgartigimod as a fast-acting add-on therapy in manifest and impending myasthenic crisis: A single-center case series","volume":"395","author":"Hong","year":"2024","journal-title":"J Neuroimmunol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1418503","article-title":"Efgartigimod as a promising add-on therapy for myasthenic crisis: a prospective case series","volume":"15","author":"Song","year":"2024","journal-title":"Front Immunol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.52142","article-title":"Efgartigimod for generalized myasthenia gravis: A multicenter real-world cohort study in China","volume":"11","author":"Luo","year":"2024","journal-title":"Ann Clin Trans Neurol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1002\/mus.27974","article-title":"Safety and outcomes with efgartigimod use for acetylcholine receptor-positive generalized myasthenia gravis in clinical practice","volume":"68","author":"Katyal","year":"2023","journal-title":"Muscle Nerve"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.40.5.786","article-title":"The relationship of age to outcome in myasthenia gravis","volume":"40","author":"Donaldson","year":"1990","journal-title":"Neurology"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1602489","article-title":"Randomized trial of thymectomy in myasthenia gravis","volume":"375","author":"Wolfe","year":"2016","journal-title":"New Engl J Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1046\/j.1365-2125.2003.02007.x","article-title":"Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications","volume":"57","author":"Mangoni","year":"2004","journal-title":"Br J Clin Pharmacol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-023-07122-y","article-title":"Efgartigimod improves triple-negative myasthenia gravis","volume":"45","author":"Frangiamore","year":"2024","journal-title":"Neurological Sci"},{"key":"B23","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1002\/mus.28003","article-title":"Single institution experience with efgartigimod in patients with myasthenia gravis: Patient selection, dosing schedules, treatment response, and adverse events","volume":"69","author":"Singer","year":"2024","journal-title":"Muscle Nerve"},{"key":"B24","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":"B25","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/B978-0-12-823912-4.00026-8","article-title":"Myasthenia gravis-Pathophysiology, diagnosis, and treatment","volume":"200","author":"Tannemaat","year":"2024","journal-title":"Handb Clin Neurol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1172\/JCI97911","article-title":"Neonatal Fc receptor antagonist efgartigimod safely and sustainably reduces IgGs in humans","volume":"128","author":"Ulrichts","year":"2018","journal-title":"J Clin Invest"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2025.1579859","article-title":"Efgartigimod as a fast-acting treatment in generalized very-late-onset myasthenia gravis","volume":"16","author":"Zhang","year":"2025","journal-title":"Front Immunol"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1685233\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T11:46:11Z","timestamp":1762429571000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1685233\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,6]]},"references-count":27,"alternative-id":["10.3389\/fimmu.2025.1685233"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2025.1685233","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,6]]},"article-number":"1685233"}}