{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:53:56Z","timestamp":1791262436277,"version":"4.1.0"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"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>Generalized Myasthenia gravis (gMG) is a rare autoimmune disorder of the neuromuscular junction caused by IgG autoantibodies against antigens in the postsynaptic cleft. This study aimed to assess the real-world effectiveness and safety of Efgartigimod (EFG) in AChR-positive gMG with overlapping autoimmune comorbidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>EFG was administered as 4 consecutive weekly infusions or injections. Myasthenia Gravis Activity of Daily Living (MG-ADL) and Myasthenia Gravis quantitative (QMG) scales were administered at baseline and after 4\u202fweeks. Clinical data on autoimmune comorbidities and prednisone use were collected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>35 patients (20 women, mean age 53.6\u202fyears) received EFG, with a significant and clinical improvement in both MG-ADL and QMG scores. MG-ADL responder rate (MG-ADL reduction\u22652) was 79%, while 68% on QMG (QMG reduction\u22653); Minimal symptoms expression was reached in 4 patients, with a mean reduction in daily prednisone dose of 8\u202fmg. Overlapping autoimmune comorbidity was reported in 12 gMG patients (34%). gMG patients with Stiff-Person syndrome, type 1 Diabetes and Lambert-Eaton myasthenic syndrome benefited more from EFG with a higher reduction on MG-ADL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Overlapping autoimmune comorbidity is not rare. EFG demonstrated a meaningful clinical benefit in patients with AChR-positive gMG with overlapping IgG-mediated disorders.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1919993","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:25:46Z","timestamp":1791260746000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The effect of FcRn inhibition on overlapping autoimmune comorbidity in AChR-seropositive generalized myasthenia gravis"],"prefix":"10.3389","volume":"17","author":[{"given":"Vincenzo","family":"Di Stefano","sequence":"first","affiliation":[{"name":"Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo","place":["Palermo, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicasio","family":"Rini","sequence":"additional","affiliation":[{"name":"Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo","place":["Palermo, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Campo","sequence":"additional","affiliation":[{"name":"Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo","place":["Palermo, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flora","family":"D\u2019Amico","sequence":"additional","affiliation":[{"name":"Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo","place":["Palermo, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurora","family":"Meli","sequence":"additional","affiliation":[{"name":"Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo","place":["Palermo, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Maccora","sequence":"additional","affiliation":[{"name":"Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo","place":["Palermo, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Brighina","sequence":"additional","affiliation":[{"name":"Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo","place":["Palermo, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliana","family":"Bevilacqua","sequence":"additional","affiliation":[{"name":"Neurology Unit, Department of Medicine, Surgery and Dentistry \"Scuola Medica Salernitana, Neuroscience Section, University Hospital \u201cSan Giovanni di Dio e Ruggi d\u2019Aragona","place":["Salerno, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Barone","sequence":"additional","affiliation":[{"name":"Neurology Unit, Department of Medicine, Surgery and Dentistry \"Scuola Medica Salernitana, Neuroscience Section, University Hospital \u201cSan Giovanni di Dio e Ruggi d\u2019Aragona","place":["Salerno, Italy"]},{"name":"IRCCS SYNLAB- SDN","place":["Napoli, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alba Rosa","family":"Pati","sequence":"additional","affiliation":[{"name":"Neurology\/Stroke Unit, Hospital A. Perrino","place":["Brindisi, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariangela","family":"Ferrara","sequence":"additional","affiliation":[{"name":"Neurology\/Stroke Unit, Hospital A. Perrino","place":["Brindisi, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augusto Maria","family":"Rini","sequence":"additional","affiliation":[{"name":"Neurology\/Stroke Unit, Hospital A. Perrino","place":["Brindisi, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Vinciguerra","sequence":"additional","affiliation":[{"name":"Neurology Unit, Department of Medicine, Surgery and Dentistry \"Scuola Medica Salernitana, Neuroscience Section, University Hospital \u201cSan Giovanni di Dio e Ruggi d\u2019Aragona","place":["Salerno, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1878","DOI":"10.1016\/S0140-6736(23)00457-9","article-title":"Incidence, prevalence, and co-occurrence of autoimmune disorders over time and by age, sex, and socioeconomic status: a population-based cohort study of 22 million individuals in the UK","volume":"401","author":"Conrad","year":"2023","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e1002254","DOI":"10.1371\/journal.pgen.1002254","article-title":"Pervasive sharing of genetic effects in autoimmune disease","volume":"7","author":"Cotsapas","year":"2011","journal-title":"PLoS Genet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3389\/fimmu.2021.693142","article-title":"Unravelling the shared genetic mechanisms underlying 18 autoimmune diseases using a systems approach","volume":"12","author":"Gokuladhas","year":"2021","journal-title":"Front Immunol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1111\/JOIM.12310","article-title":"The autoimmune spectrum of myasthenia gravis: a Swedish population-based study","volume":"277","author":"Fang","year":"2015","journal-title":"J Intern Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1111\/j.1600-0404.1995.tb00432.x","article-title":"Associated autoimmune diseases in myasthenia gravis. A population-based study","volume":"91","author":"Christensen","year":"1995","journal-title":"Acta Neurol Scand"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3389\/FNEUR.2021.790941","article-title":"Comorbid autoimmune diseases in patients with myasthenia gravis: a retrospective cross-sectional study of a Chinese cohort","volume":"12","author":"Shi","year":"2021","journal-title":"Front Neurol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"121","DOI":"10.3109\/00207454.2010.539307","article-title":"Frequency of autoimmune diseases in myasthenia gravis: a systematic review","volume":"121","author":"Mao","year":"2011","journal-title":"Int J Neurosci"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1007\/S10072-024-07368-0","article-title":"Comorbidity in myasthenia gravis: multicentric, hospital-based, and controlled study of 178 Italian patients","author":"Di Stefano","year":"2024","journal-title":"Neurol Sci"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1016\/j.clim.2006.09.001","article-title":"Kinetics of FcRn-mediated recycling of IgG and albumin in human: pathophysiology and therapeutic implications using a simplified mechanism-based model","volume":"122","author":"Kim","year":"2007","journal-title":"Clin Immunol"},{"key":"ref10","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":"ref11","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":"ref12","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":"2024","journal-title":"Front Neurol"},{"key":"ref13","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":"ref14","doi-asserted-by":"publisher","first-page":"1293","DOI":"10.1007\/S40120-026-00923-1","article-title":"Efgartigimod in patients with generalized myasthenia gravis refractory or intolerant to IVIg","volume":"15","author":"D\u2019Amico","year":"2026","journal-title":"Neurol Ther"},{"key":"ref15","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":"ref16","doi-asserted-by":"publisher","first-page":"1648","DOI":"10.1016\/S0140-6736(23)01460-5","article-title":"Efficacy and safety of the neonatal fc receptor inhibitor efgartigimod in adults with primary immune thrombocytopenia (ADVANCE IV): a multicentre, randomised, placebo-controlled, phase 3 trial","volume":"402","author":"Broome","year":"2023","journal-title":"Lancet"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1111\/bjd.20782","article-title":"Treatment of pemphigus vulgaris and foliaceus with efgartigimod, a neonatal fc receptor inhibitor: a phase II multicentre, open-label feasibility trial","volume":"186","author":"Goebeler","year":"2022","journal-title":"Br J Dermatol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"13","DOI":"10.3389\/fimmu.2022.863095","article-title":"FcRn antagonism leads to a decrease of Desmoglein-specific B cells: secondary analysis of a phase 2 study of Efgartigimod in pemphigus vulgaris and pemphigus Foliaceus","volume":"13","author":"Maho-Vaillant","year":"2022","journal-title":"Front Immunol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.1016\/S1474-4422(24)00309-0","article-title":"Safety, tolerability, and efficacy of subcutaneous efgartigimod in patients with chronic inflammatory demyelinating polyradiculoneuropathy (ADHERE): a multicentre, randomised-withdrawal, double-blind, placebo-controlled, phase 2 trial","volume":"23","author":"Allen","year":"2024","journal-title":"Lancet Neurol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/s12883-025-04034-6","article-title":"Successful treatment with efgartigimod as an add-on therapy for acute attack of anti-NMDA receptor encephalitis: a case report","volume":"25","author":"Huang","year":"2025","journal-title":"BMC Neurol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1995","DOI":"10.1007\/s10072-024-07843-8","article-title":"Efgartigimod treatment for therapy-refractory autoimmune encephalitis with coexistent NMDAR and LGI1 antibodies: a case report and literature review","volume":"46","author":"Xu","year":"2025","journal-title":"Neurol Sci"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"106983","DOI":"10.1016\/j.imlet.2025.106983","article-title":"Efficacy and safety of efgartigimod in patients with neurological autoimmune diseases","volume":"273","author":"Qin","year":"2025","journal-title":"Immunol Lett"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/S1474-4422(23)00077-7","article-title":"Safety and efficacy of rozanolixizumab in patients with generalised myasthenia gravis (MycarinG): a randomised, double-blind, placebo-controlled, adaptive phase 3 study","volume":"22","author":"Bril","year":"2023","journal-title":"Lancet Neurol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1001\/jamaneurol.2024.0044","article-title":"Batoclimab vs placebo for generalized myasthenia gravis: a randomized clinical trial","volume":"81","author":"Yan","year":"2024","journal-title":"JAMA Neurol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/S1474-4422(24)00498-8","article-title":"Safety and efficacy of nipocalimab in adults with generalised myasthenia gravis (vivacity-MG3): a phase 3, randomised, double-blind, placebo-controlled study","volume":"24","author":"Antozzi","year":"2025","journal-title":"Lancet Neurol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"10","DOI":"10.3389\/fimmu.2019.01540","article-title":"The neonatal fc receptor (FcRn): a misnomer?","volume":"10","author":"Pyzik","year":"2019","journal-title":"Front Immunol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"6511","DOI":"10.1182\/blood-2009-01-129155","article-title":"The ITP syndrome: pathogenic and clinical diversity","volume":"113","author":"Cines","year":"2009","journal-title":"Blood"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1038\/S41572-019-0079-Y","article-title":"Myasthenia gravis","volume":"5","author":"Gilhus","year":"2019","journal-title":"Nat Rev Dis Primers"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/S00415-023-11970-1\/TABLES\/3","article-title":"Efgartigimod beyond myasthenia gravis: the role of FcRn-targeting therapies in stiff-person syndrome","volume":"1","author":"Di Stefano","year":"2023","journal-title":"J Neurol"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2025.1605985","article-title":"Case report: therapeutic effect of efgartigimod in refractory anti-GQ1b antibody syndrome coexisting with myasthenia gravis","volume":"16","author":"Watanabe","year":"2025","journal-title":"Front Immunol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1111","DOI":"10.1007\/s10072-019-03746-1","article-title":"Italian recommendations for the diagnosis and treatment of myasthenia gravis","author":"Evoli","year":"2019","journal-title":"Neurol Sci"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1007\/s40265-022-01678-3","article-title":"Efgartigimod: first approval","volume":"82","author":"Heo","year":"2022","journal-title":"Drugs"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1007\/s40263-023-01000-z","article-title":"Efgartigimod alfa in generalised myasthenia gravis: a profile of its use","volume":"37","author":"Heo","year":"2023","journal-title":"CNS Drugs"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"9927870","DOI":"10.1155\/ane\/9927870","article-title":"Identifying red flags in myasthenia gravis diagnosis, reassessment, and myasthenic crisis: an Italian Delphi-based position paper","volume":"1","author":"Habetswallner","year":"2026","journal-title":"Acta Neurol Scand"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e70563","DOI":"10.1111\/ENE.70563","article-title":"Minimal symptom expression in generalized myasthenia gravis: a valuable patient-centric treatment goal","volume":"33","author":"Meisel","year":"2026","journal-title":"Eur J Neurol"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1100","DOI":"10.1002\/mus.70013","article-title":"Comparison of the quantitative myasthenia gravis and myasthenia gravis activity of daily living scores from a clinical practice perspective","volume":"72","author":"Wu","year":"2025","journal-title":"Muscle Nerve"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1111\/ANE.13254","article-title":"Prevalence and risk of thyroid diseases in myasthenia gravis","volume":"142","author":"Chou","year":"2020","journal-title":"Acta Neurol Scand"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"e00537","DOI":"10.1002\/brb3.537","article-title":"Prevalence and impact of autoimmune thyroid disease on myasthenia gravis course","volume":"6","author":"Kubiszewska","year":"2016","journal-title":"Brain Behav"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"832","DOI":"10.1007\/s13311-022-01188-w","article-title":"Stiff-person syndrome and GAD antibody-spectrum disorders: GABAergic neuronal excitability, Immunopathogenesis and update on antibody therapies","volume":"19","author":"Dalakas","year":"2022","journal-title":"Neurotherapeutics"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1531","DOI":"10.1212\/WNL.55.10.1531","article-title":"The clinical spectrum of anti-GAD antibody-positive patients with stiff-person syndrome","volume":"55","author":"Dalakas","year":"2000","journal-title":"Neurology"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"4221","DOI":"10.3390\/jcm14124221","article-title":"Risk of diabetes mellitus in the myasthenia gravis: a systematic review and Meta-analysis","volume":"14","author":"Giannopapas","year":"2025","journal-title":"J Clin Med"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1007\/s40120-025-00857-0","article-title":"Efgartigimod as fast-acting rescue therapy in very late-onset myasthenia gravis","volume":"15","author":"Rini","year":"2025","journal-title":"Neurol Ther."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1002\/mus.24921","article-title":"Myasthenia gravis Lambert-Eaton overlap syndrome","volume":"53","author":"Oh","year":"2016","journal-title":"Muscle Nerve"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1507","DOI":"10.2147\/IMCRJ.S555977","article-title":"Case report: a patient with Lambert-Eaton Myasthenic syndrome successfully treated with Efgartigimod","volume":"18","author":"Han","year":"2025","journal-title":"Int Med Case Rep J"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1093\/rheumatology\/key236","article-title":"Thymectomy in patients with myasthenia gravis increases the risk of autoimmune rheumatic diseases: a nationwide cohort study","volume":"58","author":"Chang","year":"2019","journal-title":"Rheumatology"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"544885","DOI":"10.3389\/fneur.2020.00939","article-title":"Myasthenia gravis coexisting with primary Sj\u00f6gren\u2019s syndrome: report of three cases and literature review","volume":"11","author":"Li","year":"2020","journal-title":"Front Neurol"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1146\/annurev-pathmechdis-031521-032634","article-title":"The Immunobiology and pathogenesis of celiac disease","volume":"18","author":"Iversen","year":"2023","journal-title":"Annu Rev Pathol"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1919993\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:25:47Z","timestamp":1791260747000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1919993\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,6]]},"references-count":47,"alternative-id":["10.3389\/fneur.2026.1919993"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1919993","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,6]]},"article-number":"1919993"}}