2 strategies for treating gMG each work with 1 treatment, study finds
Both approved med, blood-cleaning procedure significantly ease symptoms
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- A new analysis comparing two different types of treatment for generalized myasthenia gravis found them about equally effective.
- Both the approved drug Vyvgart and a blood-cleaning procedure called plasmapheresis significantly eased symptoms in people with gMG.
- Each strategy also worked to reduce disease-causing antibodies with a single treatment course.
A new study comparing outcomes of two different strategies for treating generalized myasthenia gravis (gMG) found that both the approved med Vyvgart (efgartigimod alfa) and a blood-cleaning procedure called double-filtration plasmapheresis (DFPP) were generally equally effective in easing symptoms.
Both treatments significantly reduced disease-causing antibodies and improved daily function in people living with gMG, the data showed. Moreover, according to the researchers, each showed benefits with a single treatment course.
The small study, conducted by a research team in China, overall found no statistically significant differences between the two treatments in the magnitude of these short-term changes after one round of treatment. However, the groups differed in some respects at the study’s start, with patients who received DFPP tending to have more severe disease, per the team.
The researchers concluded that both treatments “effectively reduced antibody levels and improved clinical symptoms in patients with gMG after a single treatment course.”
Nonetheless, the team noted that the newer treatment Vyvgart “offers several practical advantages” compared with plasmapheresis, “including reduced procedural trauma, improved patient comfort, and greater convenience in administration.” As such, the researchers called for larger studies tracking participants for a longer time to more thoroughly compare the two gMG treatments.
The study, “Efficacy and Safety of Double-Filtration Plasmapheresis Versus Efgartigimod in Generalized Myasthenia Gravis: A Single-Center Retrospective Study,” was published in the Journal of Clinical Apheresis.
An autoimmune neuromuscular disorder, gMG is caused by self-reactive antibodies that mistakenly attack proteins involved in communication between nerves and muscles. As a result, muscles become weak and tire more easily.
In most cases, these antibodies target the acetylcholine receptor (AChR) protein and predominantly belong to the IgG antibody class. Smaller amounts of IgM and IgA antibodies against AChR have also been detected in some patients.
Standard treatments for gMG can control symptoms but may take time to reach their full effect, the researchers noted. Given this, faster-acting medications may be needed when symptoms worsen rapidly or when conventional therapy does not provide adequate control.
2 treatments used for different patients in real world, per scientists
Plasmapheresis is a blood-filtering treatment that can rapidly lower levels of disease-causing antibodies in the blood. DFPP specifically uses a second filter to selectively remove large molecules, including harmful antibodies and immune complexes.
Vyvgart is an infusion therapy approved for gMG that works by blocking neonatal Fc receptor, a protein that normally protects circulating IgG antibodies from being broken down. The medication thus accelerates the destruction of IgG antibodies, including those driving gMG.
Both DFPP and Vyvgart are increasingly used to rapidly lower disease-causing antibodies in gMG, but few studies have directly compared their effects. To address this gap, researchers at Shanghai Jiao Tong University School of Medicine compared the short-term effectiveness and safety of the two treatments in people with gMG.
The team retrospectively analyzed data from 31 gMG patients treated at a single center in China between January 2021 and June 2025. The patients’ median age was 65 and nearly three-quarters were women. Most (81%) tested positive for anti-AChR antibodies.
A total of 17 received DFPP, while 14 were given Vyvgart; none received both treatments. DFPP treatment consisted of five sessions given every other day, while Vyvgart treatment comprised four weekly infusions.
At the study’s start (baseline), DFPP-treated patients were significantly younger (mean of 51.9 vs. 68.7 years) and had significantly higher scores in the Quantitative Myasthenia Gravis (QMG) scale, indicating greater muscle weakness.
Scores in the MG Activities of Daily Living (MG-ADL), which measures the disease’s impact on everyday activities, were also higher in the DFPP group, although that difference did not reach statistical significance.
The team noted that these differences in disease severity likely reflect real-world treatment decisions. DFPP is generally used in patients with greater disease activity, rapid worsening, or a need for urgent rescue or bridge therapy, whereas Vyvgart is more often chosen for patients stable enough to complete a four-week infusion course.
No significant differences seen between 2 strategies
The data showed no significant differences in terms of IgG level reduction between the two treatments.
The researchers noted that DFPP significantly reduced mean IgG levels from 10.94 to 2.97 g/L, representing a 73% drop. Meanwhile, levels of IgA fell by about 75% and IgM by 73%. But among Vyvgart-treated patients, mean IgG levels also fell significantly, from 11.60 to 5.38 g/L.
Anti-AChR antibody levels were also significantly lowered with either treatment. Data from paired antibody measurements of seven DFPP-treated patients and 10 Vyvgart-treated patients showed no statistically significant differences between the treatments, the team noted.
In the DFPP group, mean QMG scores fell (improved) significantly from 17.82 to 6.12, while mean MG-ADL scores significantly declined (improved) from 10.29 to 2.59. Among patients treated with Vyvgart, median QMG scores also fell significantly, from 11 to 2.5, while mean MG-ADL scores dropped significantly from 7.57 to 1.36.
When researchers compared the magnitude of score changes between treatments, they found no significant differences. The result remained the same after adjusting for age and the corresponding baseline disease score.
[The] data suggest that DFPP and [Vyvgart] produced broadly comparable [outcomes among people with gMG].
Four DFPP-treated patients experienced mild adverse events, including catheter-site bleeding, temporary limb weakness, vomiting, facial numbness, and chest tightness. No Vyvgart-related adverse events were reported. There were no serious adverse events in either group.
Because adverse events have been reported in larger Vyvgart studies, the researchers cautioned that their absence in this study may reflect the small sample, short observation period, and incomplete recording of mild events.
These findings indicate that both treatments “were associated with short-term reductions in [disease-causing] antibody levels and improvements in MG-ADL and QMG scores after one treatment course,” the researchers wrote.
Overall, according to the team, the “data suggest that DFPP and [Vyvgart] produced broadly comparable [outcomes]” among the patients in this study. Still, the researchers noted its small size and short duration, and concluded that “to further validate the efficacy and safety of DFPP and [Vyvgart] in gMG, large-scale, multicenter … studies [following patients over time] are warranted.”
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