{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T03:53:30Z","timestamp":1788666810565,"version":"build-2803163510"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"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>Background<\/jats:title>\n                    <jats:p>Generalized myasthenia gravis (gMG) is commonly treated with high-dose intravenous immunoglobulin (IVIG), typically at cumulative doses near 2\u202fg\/kg, during clinical worsening. However, the minimal effective IVIG exposure remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this prospective single-center cohort study, we enrolled 34 adults with AChR-positive gMG who received either low-dose IVIG (target \u22640.2\u202fg\/kg\/day;\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f21) or standard-dose IVIG (target 0.4\u202fg\/kg\/day;\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f13) according to routine clinical practice. Clinical outcomes were assessed using the Myasthenia Gravis Activities of Daily Living (MG-ADL) scale and the Quantitative Myasthenia Gravis (QMG) score at baseline and at weeks 1, 2, 4, 8, and 12. For the index IVIG course, infusion days, cumulative dose, and primary treatment indication were recorded. Oral prednisone use was evaluated as a short-term steroid-sparing outcome. Between-group comparisons were explored using regression models adjusted for age and thymoma status.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Both regimens were associated with clinically meaningful improvement in MG-ADL and QMG through week 12, and no statistically significant between-group differences were detected at any follow-up visit. Most patients received 5 infusion days. After weight-based conversion, the low-dose group clustered around a cumulative exposure of approximately 1.0\u202fg\/kg, whereas the standard-dose group clustered around approximately 2.0\u202fg\/kg. Acute exacerbation was the most common indication in both groups, whereas maintenance therapy was more frequent in the standard-dose cohort. Prednisone requirements did not decline over 12\u202fweeks in either group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this prospective observational cohort, low-dose IVIG was associated with short-term clinical improvement comparable to that observed with standard-dose IVIG, without a clear steroid-sparing signal. These findings should be interpreted cautiously given the small sample size, baseline imbalance, and non-randomized design.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1780647","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T04:52:50Z","timestamp":1777351970000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Low-dose versus standard-dose intravenous immunoglobulin in generalized myasthenia gravis: a prospective single-center cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Haocheng","family":"Luo","sequence":"first","affiliation":[{"name":"The First Clinical Medical College of Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Dong","sequence":"additional","affiliation":[{"name":"The First Clinical Medical College of Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Yang","sequence":"additional","affiliation":[{"name":"The First Clinical Medical College of Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yufei","family":"Deng","sequence":"additional","affiliation":[{"name":"The First Clinical Medical College of Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaoyue","family":"Zhang","sequence":"additional","affiliation":[{"name":"The First Clinical Medical College of Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuxiang","family":"Zhang","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liqing","family":"Hu","sequence":"additional","affiliation":[{"name":"The First Clinical Medical College of Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenyu","family":"Wu","sequence":"additional","affiliation":[{"name":"The First Clinical Medical College of Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojun","family":"Yang","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qilong","family":"Jiang","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine","place":["Guangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"ref1","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":"ref2","doi-asserted-by":"publisher","first-page":"e213428","DOI":"10.1212\/wnl.0000000000213428","article-title":"Cost trends of new-to-market neurologic medications: an insurance claims database analysis","volume":"104","author":"Gusovsky Chevalier","year":"2025","journal-title":"Neurology"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2397","DOI":"10.1007\/s13311-021-01108-4","article-title":"Update on intravenous immunoglobulin in neurology: modulating neuro-autoimmunity, evolving factors on efficacy and dosing and challenges on stopping chronic IVIg therapy","volume":"18","author":"Dalakas","year":"2021","journal-title":"Neurotherapeutics"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1038\/nrneurol.2014.253","article-title":"Intravenous immunoglobulin in neurology--mode of action and clinical efficacy","volume":"11","author":"L\u00fcnemann","year":"2015","journal-title":"Nat Rev Neurol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"Cd002277","DOI":"10.1002\/14651858.CD002277.pub4","article-title":"Intravenous immunoglobulin for myasthenia gravis","volume":"2012","author":"Gajdos","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2286","DOI":"10.1111\/trf.18031","article-title":"The impact of institutional measures on optimal use of intravenous immunoglobulin","volume":"64","author":"Champagne","year":"2024","journal-title":"Transfusion"},{"key":"ref7","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":"ref8","doi-asserted-by":"publisher","first-page":"17562864231213240","DOI":"10.1177\/17562864231213240","article-title":"Guideline for the management of myasthenic syndromes","volume":"16","author":"Wiendl","year":"2023","journal-title":"Ther Adv Neurol Disord"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2207","DOI":"10.1002\/eji.201444700","article-title":"European consensus proposal for immunoglobulin therapies","volume":"44","author":"Sewell","year":"2014","journal-title":"Eur J Immunol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1111\/j.1468-1331.2010.03019.x","article-title":"Guidelines for treatment of autoimmune neuromuscular transmission disorders","volume":"17","author":"Skeie","year":"2010","journal-title":"Eur J Neurol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1038\/s41582-020-0400-0","article-title":"Complement in neurological disorders and emerging complement-targeted therapeutics","volume":"16","author":"Dalakas","year":"2020","journal-title":"Nat Rev Neurol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s00415-024-12768-5","article-title":"Medical costs of treating myasthenia gravis in patients who need intravenous immunoglobulin (IVIg)\u2014a register-based study","volume":"272","author":"Bugge","year":"2024","journal-title":"J Neurol"},{"key":"ref13","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":"ref14","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1007\/s40265-022-01726-y","article-title":"Pharmacotherapy of generalized myasthenia gravis with special emphasis on newer biologicals","volume":"82","author":"Menon","year":"2022","journal-title":"Drugs"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e70158","DOI":"10.1111\/ene.70158","article-title":"Long-term efficacy and safety of Ravulizumab in adults with anti-acetylcholine receptor antibody-positive generalized myasthenia gravis: final results from the phase 3 CHAMPION MG open-label extension","volume":"32","author":"Vu","year":"2025","journal-title":"Eur J Neurol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1007\/s00415-025-13127-8","article-title":"Ravulizumab for generalized myasthenia gravis: a multicenter real-life experience","volume":"272","author":"Rossini","year":"2025","journal-title":"J Neurol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1284444","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":"2023","journal-title":"Front Neurol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1002\/mus.28289","article-title":"Efficacy and safety of maintenance intravenous immunoglobulin in generalized myasthenia gravis patients with acetylcholine receptor antibodies: a multicenter, double-blind, placebo-controlled trial","volume":"71","author":"Bril","year":"2025","journal-title":"Muscle Nerve"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1780647\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T04:53:01Z","timestamp":1777351981000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1780647\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,28]]},"references-count":18,"alternative-id":["10.3389\/fneur.2026.1780647"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1780647","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,28]]},"article-number":"1780647"}}