FcRn antagonist and C5 complement inhibitor as early rescue strategies in severe Myasthenia Gravis: a two-case report
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By
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Mosè Parisi
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Nicola Molitierno
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Claudia Alberti
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Delia Gagliardi
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Daniele Velardo
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Giacomo Pietro Comi
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Stefania Paola Corti
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June 19, 2026
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Clinical Scorecard: Early Intervention with FcRn Antagonists and C5 Complement Inhibitors in Severe Myasthenia Gravis: A Report on Two Cases
At a Glance
| Category | Detail |
|---|
| Condition | Myasthenia Gravis |
| Key Mechanisms | FcRn antagonists inhibit IgG recycling; C5 complement inhibitors prevent MAC formation. |
| Target Population | Patients with severe generalized AChR antibody-positive Myasthenia Gravis refractory to standard therapies. |
| Care Setting | Clinical management of severe autoimmune neuromuscular disorders. |
Key Highlights
- 10-15% of generalized AChR antibody-positive MG patients develop refractoriness to standard therapies.
- Early use of FcRn antagonists and C5 inhibitors shows rapid clinical stabilization.
- Case reports demonstrate significant improvement in MG-ADL scores with advanced therapies.
- Efgartigimod and ravulizumab were used off-label with positive outcomes.
- Further studies are needed to define optimal criteria for early integration of these therapies.
Guideline-Based Recommendations
Diagnosis
- Diagnosis of generalized MG confirmed by serum anti-AChR antibodies and repetitive nerve stimulation.
Management
- Consider advanced therapies like FcRn antagonists and C5 inhibitors for refractory cases.
Monitoring & Follow-up
- Monitor MG-ADL and QMG scores to assess treatment response.
Risks
- Monitor for adverse events associated with immunosuppressive therapies.
Patient & Prescribing Data
Patients with severe, refractory Myasthenia Gravis requiring advanced therapeutic strategies.
Efgartigimod and ravulizumab can lead to rapid clinical improvement and stabilization.
Clinical Best Practices
- Utilize advanced therapies as a bridging strategy to thymectomy in severe MG cases.
- Initiate treatment early in the course of severe MG to improve outcomes.
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