{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:41:04Z","timestamp":1792172464810,"version":"4.4.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"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. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Efgartigimod, an FcRn antagonist that reduces circulating immunoglobulin G (IgG), is approved for the treatment of acetylcholine receptor (AChR) antibody\u2013positive generalized myasthenia gravis (gMG). While its efficacy has been demonstrated in randomized clinical trials, real-world data describing longitudinal use and management of efgartigimod in routine clinical practice are still emerging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective observational study across two neuromuscular referral centers, including adults with AChR antibody\u2013positive gMG treated with intravenous efgartigimod between April 2023 and August 2025. Treatment was initiated across a range of real-world clinical scenarios, including refractory disease, non-crisis symptom relapse, corticosteroid tapering, maintenance of minimal-symptom expression, and bridging before thymectomy or initiation of conventional immunosuppression. Retreatment intervals were individualized based on clinical course. Clinical outcomes, corticosteroid use, serological markers, adjunctive therapies, and safety events were analyzed descriptively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirteen patients received a total of 52 efgartigimod treatment cycles. Most patients experienced repeated improvement in MG-Activities of Daily Living (MG-ADL) during treatment cycles, although clinical status varied over time. Corticosteroid doses were reduced in the majority of patients during follow-up. Episodes of clinically significant worsening occurred outside the setting of myasthenic crisis and were managed with established rescue therapies, after which efgartigimod could often be resumed. Treatment was generally well tolerated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study describes how efgartigimod is integrated into routine clinical practice as part of longitudinal disease management for AChR antibody\u2013positive gMG. Real-world use encompassed diverse clinical scenarios and required individualized retreatment decisions and ongoing reassessment. These findings highlight the role of FcRn blockade as a flexible therapeutic option that complements established therapy in everyday care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1755374","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T05:38:00Z","timestamp":1768973880000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Real-world use of efgartigimod in acetylcholine receptor antibody\u2013positive generalized myasthenia gravis: experience from two centers in Greece and Cyprus"],"prefix":"10.3389","volume":"17","author":[{"given":"Tasos","family":"Tsokkos","sequence":"first","affiliation":[{"name":"Center for Neuromuscular Disorders, The Cyprus Institute of Neurology and Genetics","place":["Nicosia, Cyprus"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Strataki","sequence":"additional","affiliation":[{"name":"1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens","place":["Athens, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitra","family":"Tzavella","sequence":"additional","affiliation":[{"name":"1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens","place":["Athens, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Zamba-Papanicolaou","sequence":"additional","affiliation":[{"name":"Center for Neuromuscular Disorders, The Cyprus Institute of Neurology and Genetics","place":["Nicosia, Cyprus"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kleopas A.","family":"Kleopa","sequence":"additional","affiliation":[{"name":"Center for Neuromuscular Disorders, The Cyprus Institute of Neurology and Genetics","place":["Nicosia, Cyprus"]},{"name":"Department of Neuroscience, The Cyprus Institute of Neurology and Genetics","place":["Nicosia, Cyprus"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasiliki","family":"Zouvelou","sequence":"additional","affiliation":[{"name":"1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens","place":["Athens, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"212","DOI":"10.3389\/fimmu.2020.00212","article-title":"Autoantibody specificities in myasthenia gravis; implications for improved diagnostics and therapeutics","volume":"11","author":"Lazaridis","year":"2020","journal-title":"Front Immunol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"102646","DOI":"10.1016\/j.autrev.2020.102646","article-title":"Update on IgG4-mediated autoimmune diseases: new insights and new family members","volume":"19","author":"Koneczny","year":"2020","journal-title":"Autoimmun Rev"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1212\/WNL.0000000000011124","article-title":"International consensus guidance for Management of Myasthenia Gravis: 2020 update","volume":"96","author":"Narayanaswami","year":"2021","journal-title":"Neurology"},{"key":"ref4","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":"ref5","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10112235","article-title":"Myasthenia gravis: epidemiology, pathophysiology and clinical manifestations","volume":"10","author":"Dresser","year":"2021","journal-title":"J Clin Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1229112","DOI":"10.3389\/fneur.2023.1229112","article-title":"FcRN receptor antagonists in the management of myasthenia gravis","volume":"14","author":"Bhandari","year":"2023","journal-title":"Front Neurol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1038\/nri2155","article-title":"FcRn: the neonatal fc receptor comes of age","volume":"7","author":"Roopenian","year":"2007","journal-title":"Nat Rev Immunol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"4372","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":"ref9","doi-asserted-by":"publisher","DOI":"10.3390\/ijms22115755","article-title":"Fc-receptor targeted therapies for the treatment of myasthenia gravis","volume":"22","author":"Keller","year":"2021","journal-title":"Int J Molec Sci"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"526","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":"ref11","doi-asserted-by":"publisher","first-page":"14","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","author":"Howard","year":"2023","journal-title":"Front Neurol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"2212","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 Transl Neurol"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1111\/ene.16189","article-title":"Efgartigimod in generalized myasthenia gravis: a real-life experience at a national reference center","volume":"31","author":"Frangiamore","year":"2024","journal-title":"Eur J Neurol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"15","DOI":"10.3389\/fneur.2024.1472845","article-title":"Efgartigimod treatment for generalized myasthenia gravis: a single-center case series of 16 patients","volume":"15","author":"Nomura","year":"2024","journal-title":"Front Neurol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1177\/17562864251319656","article-title":"Patterns and predictors of therapeutic response to efgartigimod in acetylcholine receptor-antibody generalized myasthenia gravis subtypes","volume":"18","author":"Jin","year":"2025","journal-title":"Ther Adv Neurol Disord"},{"key":"ref16","year":"2022"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1007\/s40120-025-00748-4","article-title":"Real-world experience with FcRn inhibitors Efgartigimod and Rozanolixizumab in myasthenia gravis: Administration in Multiple Cycles and Transition from intravenous to subcutaneous formulation","volume":"14","author":"Yoshikawa","year":"2025","journal-title":"Neurol Ther"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"3462","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":"ref19","doi-asserted-by":"publisher","first-page":"762","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":"ref20","doi-asserted-by":"publisher","first-page":"6209","DOI":"10.1007\/s00415-024-12588-7","article-title":"A real-life experience with eculizumab and efgartigimod in generalized myasthenia gravis patients","volume":"271","author":"Pane","year":"2024","journal-title":"J Neurol"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1111\/cns.70391","article-title":"Efficacy and safety of Efgartigimod for patients with myasthenia gravis in a real-world cohort of 77 patients","volume":"31","author":"Hao","year":"2025","journal-title":"CNS Neurosci Ther"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1136\/jnnp-2024-334086","article-title":"Efgartigimod efficacy and safety in refractory myasthenia gravis: UK\u2019S first real-world experience","volume":"96","author":"Dion\u00edsio","year":"2025","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1162","DOI":"10.1002\/acn3.70051","article-title":"ADAPT NXT: fixed cycles or every-other-week IV Efgartigimod in generalized myasthenia gravis","volume":"12","author":"Habib","year":"2025","journal-title":"Ann Clin Transl Neurol"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines12061214","article-title":"Real-world case series of Efgartigimod for Japanese generalized myasthenia gravis: well-tailored treatment cycle intervals contribute to sustained symptom control","volume":"12","author":"Konno","year":"2024","journal-title":"Biomedicine"},{"key":"ref25","doi-asserted-by":"crossref","DOI":"10.1080\/14728214.2025.2458061","article-title":"FcRn inhibitors in the context of myasthenia gravis","volume-title":"Expert opinion on emerging drugs","author":"Menon","year":"2025"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"CD016097","DOI":"10.1002\/14651858.CD016097","article-title":"FcRn inhibitors for myasthenia gravis","volume":"2025","author":"White","year":"2025","journal-title":"Cochrane Database Syst Rev"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"123652","DOI":"10.1016\/j.jns.2025.123652","article-title":"Reduction in oral glucocorticoid use after efgartigimod initiation in clinical practice among patients with generalized myasthenia gravis","volume":"477","author":"Goyal","year":"2025","journal-title":"J Neurol Sci"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-79918-7","article-title":"Efgartigimod versus intravenous immunoglobulin in the treatment of patients with impending myasthenic crisis","volume":"14","author":"Ma","year":"2024","journal-title":"Sci Rep"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1555068","DOI":"10.3389\/fneur.2025.1555068","article-title":"Real world study in Italian public hospital with Efgartigimod in patients affected by generalized myasthenia gravis: influence of clinical and serological factors","volume":"16","author":"Sgarzi","year":"2025","journal-title":"Front Neurol"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000200455","article-title":"Unknown Immunoregulatory effects of FcRn inhibition by Efgartigimod in myasthenia gravis: a new mechanism of action beyond IgG reduction","volume":"12","author":"Tarasco","year":"2025","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"115153","DOI":"10.1016\/j.intimp.2025.115153","article-title":"FcRn inhibition with efgartigimod ameliorates muscle weakness and modulates dendritic cell subsets in an experimental autoimmune myasthenia gravis mouse model","volume":"162","author":"Shi","year":"2025","journal-title":"Int Immunopharmacol"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1755374\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T05:38:08Z","timestamp":1768973888000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1755374\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,21]]},"references-count":31,"alternative-id":["10.3389\/fneur.2026.1755374"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1755374","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,21]]},"article-number":"1755374"}}