Using approved gMG therapy may help patients prepare for thymus surgery
Vyvgart before, after tumor removal eased disease worsening for 6
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- Treatment with Vyvgart showed benefits before and after thymus surgery for six people with generalized myasthenia gravis in China.
- Researchers say these new study findings extend the approved therapy's use to the surgical setting.
- Thymectomy, a surgical procedure to remove the thymus gland, is recommended as an early treatment for gMG patients.
Among people with generalized myasthenia gravis (gMG) who undergo surgical removal of a thymus gland tumor, use of the approved infusion therapy Vyvgart (efgartigimod) — both before and after surgery — may help stabilize disease activity and reduce the risk of the condition worsening.
That’s according to data from six patients in China who had thymus surgery and experienced a reduction in disease severity with Vyvgart treatment. These individuals were ready for surgery about two weeks after first receiving the therapy, the researchers noted. After the procedure, five of them had no disease worsening. The remaining patient experienced a temporary worsening of the disease that resolved with additional Vyvgart treatment, the team reported.
Per the researchers, these findings indicate that Vyvgart “exhibits significant clinical efficacy and safety in the perioperative management of [gMG] patients with thymoma [thymus tumor] and might serve as an effective alternative to traditional therapies.” The perioperative period is the time before, during, and after surgery.
Vyvgart “rapidly optimizes preoperative status and stabilizes patients after surgery, offering a new strategy for MG,” the team wrote, noting that this work “extends [the treatment’s] use to the surgical setting.”
The results were detailed in a study titled “Perioperative Administration of Efgartigimod in myasthenia gravis patients with Thymoma: A six-case series,” which was published in the Journal of Neuroimmunology.
An autoimmune disease, gMG is caused by the production of self-reactive antibodies that target proteins involved in nerve-muscle communication, most commonly acetylcholine receptors (AChRs). Abnormalities in the thymus, a part of the immune system, are also common, with about 10%-20% of patients having a thymoma.
Thymus surgery urged early on for those with gMG
In individuals with thymoma, a thymectomy, or surgery to remove the thymus, is recommended as early as possible. The researchers noted that these patients “often present with more severe disease manifestations, are more susceptible to myasthenic crises, and exhibit enhanced perioperative risk.” Myasthenic crises are life-threatening events that affect the muscles involved in breathing.
Fast-acting medications, including intravenous immunoglobulins (IVIG) and plasmapheresis, are often used in the perioperative period to stabilize muscle weakness and prevent complications. IVIG involves the administration of healthy antibodies to suppress the antibody-mediated autoimmune responses, while plasmapheresis is a blood-cleaning procedure.
“However, their variable efficacy elicits suboptimal responses, and these procedures can be technically demanding and cause adverse effects,” the researchers wrote.
Vyvgart is a gMG-approved infusion therapy that works by accelerating the breakdown of circulating antibodies, including those that target AChRs. However, there is limited real-world evidence on its perioperative use in gMG patients with thymoma.
To learn more, a team of researchers retrospectively reviewed the medical records of six adults — five women and one man — with gMG and thymoma who underwent a thymectomy between April 2024 and March 2025 at a single Chinese hospital. All received Vyvgart before and after surgery, but not standard IVIG or plasmapheresis.
Vyvgart significantly reduced disease severity in all cases
Benefits were seen both before and after the surgeries, the researchers noted.
Disease severity, as assessed with the validated MG Activities of Daily Living (MG-ADL) and Quantitative MG Score (QMG) scales, consistently eased after the patients started Vyvgart. Immediately before surgery, mean score reductions had reached 4.7 points in MG-ADL and 9.7 points in QMG compared with before Vyvgart, indicating a significant reduction in disease severity, the team noted.
The greatest score reductions were seen in two patients with severe disease before the surgery. The researchers noted that these patients had relatively short disease duration and prominent symptoms affecting eye, mouth, and throat muscles — characteristics previously associated with better responses to Vyvgart.
“These findings indicate that perioperative [Vivgart] therapy effectively stabilizes disease activity as well as reduces symptom variability and is particularly beneficial for patients with a high risk of perioperative exacerbation,” the researchers wrote.
Additionally, the mean interval between starting Vyvgart and achieving the health conditions required to perform the surgery was 13.7 days. For some patients, MG-ADL and QMG scores continued to decrease with Vyvgart after surgery, and four attained minimal symptom expression, or no to little symptoms.
[Vyvgart] can rapidly alleviate muscle weakness [and] facilitate timely surgical intervention, as well as reduce [surgery] preparation time and the risk of … disease exacerbation.
One individual experienced a gMG exacerbation — a sudden worsening of symptoms — the day after surgery. This rapidly resolved after the patient was given Vyvgart together with injectable neostigmine, which is a medication to prevent the destruction of acetylcholine, the molecule that activates AChR. No cases of myasthenic crisis were reported, per the team.
Overall, these findings suggest that Vyvgart “can rapidly alleviate muscle weakness [and] facilitate timely surgical intervention, as well as reduce preoperative preparation time and the risk of perioperative disease exacerbation,” the researchers wrote.
The team concluded that Vyvgart was well tolerated as an adjunctive therapy to thymectomy, noting no reports of treatment-related adverse events. One patient developed an upper respiratory tract infection, but fully recovered with symptomatic and supportive treatment, without any associated gMG exacerbation.
Vyvgart “demonstrated favorable efficacy and safety in the perioperative management of [gMG] patients with thymoma, thereby providing a novel therapeutic option for immunomodulation in this setting,” the researchers wrote. However, additional studies with a larger number of participants are needed to “effectively evaluate long-term outcomes, safety, and optimal dosing strategies.”
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