{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T09:05:25Z","timestamp":1789635925832,"version":"4.0.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"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>Efgartigimod alfa, the first neonatal Fc receptor inhibitor approved for the treatment of acetylcholine receptor antibody (AChR)-positive generalized myasthenia gravis (MG), has demonstrated efficacy in randomized controlled trials. However, real-world data, particularly from Eastern Europe, remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective, multicenter study enrolled AChR-positive generalized MG patients treated with efgartigimod across six Romanian university hospitals between March 2024 and September 2025. Outcomes were assessed using the Myasthenia Gravis Activities of Daily Living (MG-ADL) scale, the Quantitative Myasthenia Gravis (QMG) score, and the Myasthenia Gravis Quality of Life 15-item revised scale (MG-QoL15r). Clinically meaningful improvement (CMI), minimal symptom expression (MSE), patient-acceptable symptom state (PASS), subdomain response, and corticosteroid sparing were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty-nine patients completed at least one treatment cycle, receiving a total of 210\u202fcycles. In cycle 1, CMI rates were 89.7% for MG-ADL and 74.4% for QMG, with a median MG-ADL reduction of 4.0 points (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001); 69.2% achieved CMI after a single infusion. Composite PASS increased from 25.6% in cycle 1 to 54.5% in cycle 8. Subdomain analysis showed improvements across all domains for both the MG-ADL and the QMG, with the exception of QMG respiratory. Among patients on corticosteroids (\n                      <jats:italic>n<\/jats:italic>\n                      =\u202f29), median prednisone dose decreased from 20.0 to 10.0\u202fmg\/day (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.004), with 58.6% achieving reduction or discontinuation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This first Eastern European real-world efgartigimod-treated cohort confirms rapid and sustained improvement and corticosteroid sparing, consistent with prior evidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1945691","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T07:46:30Z","timestamp":1788421590000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efgartigimod-alfa therapy in acetylcholine receptor antibody myasthenia gravis: Romanian experience"],"prefix":"10.3389","volume":"17","author":[{"given":"Nicolae","family":"Grecu","sequence":"first","affiliation":[{"name":"Department of Neurology, University Emergency Hospital Bucharest","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana Antonia","family":"Mihalache","sequence":"additional","affiliation":[{"name":"Department of Neurology, Fundeni Clinical Institute","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenia Irene","family":"Davidescu","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, Carol Davila University of Medicine and Pharmacy","place":["Bucharest, Romania"]},{"name":"Department of Neurology, Colentina Clinical Hospital","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodica","family":"B\u0103la\u0219a","sequence":"additional","affiliation":[{"name":"George Emil Palade University of Medicine, Pharmacy, Science and Technology","place":["T\u00e2rgu Mure\u0219, Romania"]},{"name":"First Clinic of Neurology, Mure\u0219 County Emergency Clinical Hospital","place":["T\u00e2rgu Mure\u0219, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaela","family":"Simu","sequence":"additional","affiliation":[{"name":"Victor Babe\u0219 University of Medicine and Pharmacy","place":["Timi\u0219oara, Romania"]},{"name":"Pius Br\u00eenzeu Timi\u0219oara County Emergency Clinical Hospital","place":["Timi\u0219oara, Romania"]},{"name":"NeuroTim Med","place":["Timi\u0219oara, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vitalie","family":"V\u0103c\u0103ra\u0219","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Iuliu Ha\u021bieganu University of Medicine and Pharmacy","place":["Cluj-Napoca, Romania"]},{"name":"Department of Neurology, County Emergency Clinical Hospital","place":["Cluj-Napoca, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ileana-Maria","family":"Vod\u0103","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Emergency Hospital Bucharest","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea-Ioana","family":"Mu\u0219uroi","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Emergency Hospital Bucharest","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andra M\u0103d\u0103lina","family":"Ene","sequence":"additional","affiliation":[{"name":"Department of Neurology, Fundeni Clinical Institute","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana Mihaela","family":"Petrescu","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, Carol Davila University of Medicine and Pharmacy","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina Elena","family":"Mitu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Colentina Clinical Hospital","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorena","family":"Furnic\u0103","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, Carol Davila University of Medicine and Pharmacy","place":["Bucharest, Romania"]},{"name":"Department of Neurology, Colentina Clinical Hospital","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amalia","family":"Cornea","sequence":"additional","affiliation":[{"name":"Victor Babe\u0219 University of Medicine and Pharmacy","place":["Timi\u0219oara, Romania"]},{"name":"Pius Br\u00eenzeu Timi\u0219oara County Emergency Clinical Hospital","place":["Timi\u0219oara, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romana","family":"Homorodean","sequence":"additional","affiliation":[{"name":"Department of Neurology, County Emergency Clinical Hospital","place":["Cluj-Napoca, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Crisanda","family":"V\u00eelciu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Fundeni Clinical Institute","place":["Bucharest, Romania"]},{"name":"Department of Clinical Neurosciences, Carol Davila University of Medicine and Pharmacy","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Tiu","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Emergency Hospital Bucharest","place":["Bucharest, Romania"]},{"name":"Department of Clinical Neurosciences, Carol Davila University of Medicine and Pharmacy","place":["Bucharest, Romania"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/j.ncl.2018.01.002","article-title":"Generalized Myasthenia Gravis","volume":"36","author":"Hehir","year":"2018","journal-title":"Neurol Clin"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1016\/S1474-4422(15)00145-3","article-title":"Myasthenia gravis: subgroup classification and therapeutic strategies","volume":"14","author":"Gilhus","year":"2015","journal-title":"Lancet Neurol"},{"key":"ref3","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":"ref4","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/j.jaut.2014.01.003","article-title":"Diagnostic and clinical classification of autoimmune myasthenia gravis","author":"Berrih-Aknin","year":"2014","journal-title":"J Autoimmun"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1097\/WCO.0000000000000596","article-title":"Myasthenia gravis: from autoantibodies to therapy","volume":"31","author":"Mantegazza","year":"2018","journal-title":"Curr Opin Neurol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1016\/j.ncl.2018.01.001","article-title":"Nature and action of antibodies in myasthenia gravis","volume":"36","author":"Ruff","year":"2018","journal-title":"Neurol Clin"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1016\/j.autrev.2013.03.003","article-title":"Complement associated pathogenic mechanisms in myasthenia gravis","volume":"12","author":"T\u00fcz\u00fcn","year":"2013","journal-title":"Autoimmun Rev"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1038\/nrneurol.2016.44","article-title":"Myasthenia gravis \u2014 autoantibody characteristics and their implications for therapy","volume":"12","author":"Gilhus","year":"2016","journal-title":"Nat Rev Neurol"},{"key":"ref9","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":"ref10","doi-asserted-by":"publisher","first-page":"1371","DOI":"10.1007\/s13760-024-02552-7","article-title":"Recommendations for the management of myasthenia gravis in Belgium","volume":"124","author":"De Bleecker","year":"2024","journal-title":"Acta Neurol Belg"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"419","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":"ref12","doi-asserted-by":"publisher","first-page":"116648","DOI":"10.1016\/j.jns.2019.116648","article-title":"Maintenance immunosuppression in myasthenia gravis, an update","volume":"410","author":"Morren","year":"2020","journal-title":"J Neurol Sci"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1016\/j.nrleng.2023.04.001","article-title":"A series of patients with refractory myasthenia gravis","volume":"38","author":"Garcia-Garcia","year":"2023","journal-title":"Neurologia"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"90","DOI":"10.17161\/rrnmf.v4i3.19555","article-title":"Refractory myasthenia gravis: the more we learn, the less we know","volume":"4","author":"Habib","year":"2023","journal-title":"RRNMF Neuromuscul J"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2975","DOI":"10.3390\/biomedicines13122975","article-title":"Efgartigimod for generalized myasthenia gravis and beyond: a narrative review of its pharmacological profile, clinical utility, and expanding applications","volume":"13","author":"Mansour","year":"2025","journal-title":"Biomedicine"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"3052","DOI":"10.3389\/fimmu.2019.03052","article-title":"Antagonism of the neonatal fc receptor as an emerging treatment for myasthenia gravis","volume":"10","author":"Gable","year":"2020","journal-title":"Front Immunol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2096","DOI":"10.1007\/s00415-022-11517-w","article-title":"Efgartigimod improved health-related quality of life in generalized myasthenia gravis: results from a randomized, double-blind, placebo-controlled, phase 3 study (ADAPT)","volume":"270","author":"Sacc\u00e0","year":"2023","journal-title":"J Neurol"},{"key":"ref18","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":"ref19","doi-asserted-by":"publisher","first-page":"e1617","DOI":"10.1212\/WNL.0000000000010574","article-title":"Patient-acceptable symptom states in myasthenia gravis","volume":"95","author":"Mendoza","year":"2020","journal-title":"Neurology"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e70262","DOI":"10.1111\/ene.70262","article-title":"Validation of the \u201cpatient-acceptable symptom state\u201d question as outcome measure in AChR myasthenia gravis: a multicentre","volume":"32","author":"Spagni","year":"2025","journal-title":"Prospective Study Eur J Neurol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e16098","DOI":"10.1111\/ene.16098","article-title":"Effect of efgartigimod on muscle group subdomains in participants with generalized myasthenia gravis: post hoc analyses of the phase 3 pivotal ADAPT study","volume":"31","author":"Bril","year":"2024","journal-title":"Eur J Neurol"},{"key":"ref22","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":"ref23","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":"ref24","doi-asserted-by":"publisher","first-page":"e70391","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":"ref25","doi-asserted-by":"publisher","first-page":"1752846","DOI":"10.3389\/fimmu.2026.1752846","article-title":"Real-world experience with efgartigimod in generalized myasthenia gravis: a single-center retrospective study in China","volume":"17","author":"Niu","year":"2026","journal-title":"Front Immunol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1002\/mus.28184","article-title":"Efgartigimod in refractory autoimmune myasthenia gravis","volume":"70","author":"Remijn-Nelissen","year":"2024","journal-title":"Muscle Nerve"},{"key":"ref27","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":"Moniz Dion\u00edsio","year":"2025","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref28","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":"ref29","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":"ref30","doi-asserted-by":"publisher","first-page":"00193","DOI":"10.1183\/23120541.00193-2023","article-title":"Beyond airflow obstruction: acknowledging the diversity of abnormal spirometry patterns","volume":"9","author":"Sakhamuri","year":"2023","journal-title":"ERJ Open Res"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1007\/s12028-025-02238-9","article-title":"Longitudinal improvement in respiratory function following plasma exchange in patients with severe myasthenia gravis","volume":"43","author":"Varelas","year":"2025","journal-title":"Neurocrit Care"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"859","DOI":"10.2174\/011570159X415163251205123550","article-title":"Efgartigimod in very-late-onset generalized myasthenia gravis: a real-world study on effectiveness and safety","volume":"24","author":"Ma","year":"2026","journal-title":"Curr Neuropharmacol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1579859","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"},{"key":"ref34","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":"ref35","doi-asserted-by":"publisher","first-page":"1472845","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":"ref36","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":"ref37","doi-asserted-by":"publisher","first-page":"765","DOI":"10.2147\/CLEP.S514738","article-title":"Post-marketing safety concerns with Efgartigimod alfa: a pharmacovigilance analysis based on the Food and Drug Administration adverse event reporting system database","volume":"17","author":"Huang","year":"2025","journal-title":"CLEP Epidemiol"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1510992","DOI":"10.3389\/fphar.2025.1510992","article-title":"A real-world pharmacovigilance study of efgartigimod alfa in the FDA adverse event reporting system database","volume":"16","author":"Yang","year":"2025","journal-title":"Front Pharmacol"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"e095652","DOI":"10.1136\/bmjopen-2024-095652","article-title":"Postmarketing adverse events of efgartigimod alfa: a real-world pharmacovigilance study based on the FAERS database","volume":"15","author":"Ju","year":"2025","journal-title":"BMJ Open"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1945691\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T08:42:17Z","timestamp":1789634537000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1945691\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":39,"alternative-id":["10.3389\/fneur.2026.1945691"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1945691","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"article-number":"1945691"}}