Clinical Report: Early Intervention with FcRn Antagonists and C5 Inhibitors

Background

Myasthenia gravis (MG) is an autoimmune neuromuscular disorder that can lead to significant morbidity, particularly in patients who are refractory to standard immunosuppressive therapies. Approximately 10–15% of patients with generalized AChR antibody-positive MG do not respond adequately to conventional treatments. FcRn antagonists and C5 complement inhibitors have shown promise in clinical trials, yet their early application in complex cases remains under-researched.

Data Highlights

No numerical data available in the source material.

Key Findings

• Case 1: A 75-year-old man with thymoma-associated MG showed near-complete resolution of bulbar symptoms within 48 hours of receiving efgartigimod.
• Case 2: A 74-year-old man with severe refractory bulbar MG experienced a decrease in MG-ADL score from 9 to 5 after two infusions of ravulizumab.
• Both cases demonstrate the use of advanced therapies in severe MG.
• Advanced therapies may serve as a bridging strategy to thymectomy in severe cases.
• Further prospective studies are needed to establish optimal criteria for early integration of these agents.

Clinical Implications

The cases presented indicate that early use of FcRn antagonists and C5 complement inhibitors may provide clinical stabilization in severe MG.

Related Resources & Content

1. Frontiers in Immunology, 2026 -- Case Report: Anti-LGI1 encephalitis during FcRn inhibition with efgartigimod for myasthenia gravis: implications for the limitations of IgG recycling blockade
2. Frontiers in Neurology, 2026 -- Efgartigimod for generalized myasthenia gravis: a comprehensive review of clinical evidence and future perspectives
3. Frontiers in Immunology, 2026 -- Complement C5 inhibition in generalized myasthenia gravis is associated with improved survival and increased cardiovascular risk
4. Association of British Neurologists (ABN) autoimmune myasthenia gravis management guidelines (2025 update)
5. Acta Neuropathologica — Complement Activation at the Neuromuscular Junction in Seronegative Myasthenia Gravis
6. Association of British Neurologists (ABN) autoimmune myasthenia gravis management guidelines (2025 update)
7. Safety and efficacy of eculizumab in anti-acetylcholine receptor antibody-positive refractory generalised myasthenia gravis (REGAIN): a phase 3, randomised, double-blind, placebo-controlled, multicentre study - PubMed
8. 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+) - PMC