Abstract Details

Title Changes in Nonsteroidal Immunosuppressive Treatment Usage Before and After Efgartigimod Initiation in Patients with Myasthenia Gravis

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P1 - Poster Session 1 (11:45 AM-12:45 PM)

Poster/Presentation
Number 11-015

Objective

To evaluate changes in utilization of nonsteroidal immunosuppressive treatments (NSISTs) before and after efgartigimod initiation in patients with myasthenia gravis (MG).

Background

While reduction in usage of oral glucocorticoids after efgartigimod initiation has been previously observed in the United States (US), evidence is limited regarding the impact on NSIST utilization.

Design/Methods

In this retrospective cohort study, patients with MG who initiated and continued efgartigimod treatment for at least 1-year were identified from a US medical and pharmacy claims database (based on information licensed from IQVIA: Longitudinal Access and Adjudication Data [LAAD] for the period April 2016−January 2024, reflecting estimates of real-world activity [all rights reserved]). Patients who had any usage of mycophenolate mofetil (MMF) or azathioprine (AZA) during the 90-day period immediately prior to efgartigimod initiation (index date) were selected. Mean (SD) average daily dose (ADD) of MMF and AZA was evaluated at baseline (during the 90 days immediately prior to index) and at 12-months after efgartigimod initiation (Days 330-360 after index).

Results

103 patients with MMF usage and 60 patients with AZA usage before index were included. Mean (SD) age was 61.7 (12.9) years and 39% (n=40/103) were female in the MMF cohort. Mean (SD) age was 56.1 (15.4) years and 48% (n=29/60) were female in the AZA cohort. Among the MMF cohort, mean ADD (SD) of MMF significantly dropped from 1629.4 (862.7) mg/day at baseline to 1301.6 (1166.6) mg/day after efgartigimod initiation (P<0.05). Among the AZA cohort, mean ADD (SD) of AZA significantly dropped from 131.1 (80.4) mg/day to 92.4 (81.5) mg/day after efgartigimod initiation (P<0.05).

Conclusions

Based on US claims, overall ADD for both MMF and AZA were significantly reduced in patients who continued efgartigimod treatment for ≥1-year.

Authors/Disclosures
Pushpa Narayanaswami, MD, MBBS, FAAN (Beth Israel Deaconess Medical Center) PRESENTER	Dr. Narayanaswami has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for UCB. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CVS. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Narayanaswami has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx USA. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Narayanaswami has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx. Dr. Narayanaswami has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NMD pharma. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD-Serono (Merck usa). Dr. Narayanaswami has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Immuneabs. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Viridian. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cabaletta-Bio. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Immunovant. Dr. Narayanaswami has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Dianthus. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cartesian. Dr. Narayanaswami has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Vor Bio. Dr. Narayanaswami has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Muscle and Nerve, Wiley. Dr. Narayanaswami has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology. Dr. Narayanaswami has or had stock in Dr. Reddys laboratories.Dr. Narayanaswami has or had stock in Doximity. The institution of Dr. Narayanaswami has received research support from Alexion. The institution of Dr. Narayanaswami has received research support from NIH. The institution of Dr. Narayanaswami has received research support from Argenx. The institution of Dr. Narayanaswami has received research support from Cabaletta Bio. Dr. Narayanaswami has received publishing royalties from a publication relating to health care. Dr. Narayanaswami has a non-compensated relationship as a Member, Finance Committee with AANEM that is relevant to AAN interests or activities.
Cynthia Qi (argenx)	Cynthia Qi has received personal compensation for serving as an employee of argenx.
Neelam Goyal, MD, FAAN (Stanford University)	Dr. Goyal has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Argenx. Dr. Goyal has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Goyal has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Janssen. Dr. Goyal has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Goyal has received research support from Argenx.
A. Gordon Smith, MD, FAAN (VCU Health System Department of Neurology)	Dr. Smith has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Smith has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Argenx. Dr. Smith has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merz. Dr. Smith has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sangamo. Dr. Smith has received personal compensation in the range of $500-$4,999 for serving as a Consultant for US Department of Justice. Dr. Smith has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Smith has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Eidos. Dr. Smith has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Lexicon. Dr. Smith has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. The institution of Dr. Smith has received research support from NIH (NINDS, NIDDK). Dr. Smith has received publishing royalties from a publication relating to health care. Dr. Smith has received personal compensation in the range of $0-$499 for serving as a Study Section with NIH.
Arash Mahajerin, MD, MSCr	Dr. Mahajerin has received personal compensation for serving as an employee of argenx. Dr. Mahajerin has stock in argenx.
Renee Campbell, MD	Dr. Campbell has received personal compensation for serving as an employee of argenx. Dr. Campbell has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for Guidehouse.
Matt Jefferson	Matt Jefferson has received personal compensation for serving as an employee of argenx. Matt Jefferson has stock in argenx.
Rohit Menon	Rohit Menon has received personal compensation for serving as an employee of ZS Associates.
Sam Selvaraj, Bachelor of Technology	Mr. Selvaraj has received personal compensation for serving as an employee of ZS Associates.
Mai Sato, PhD	Dr. Sato has received personal compensation for serving as an employee of ZS Associates.
Gil I. Wolfe, MD, FAAN (Univ. At Buffalo, SUNY)	Dr. Wolfe has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Grifols. Dr. Wolfe has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Alexion. Dr. Wolfe has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for ArgenX. Dr. Wolfe has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB/Ra. Dr. Wolfe has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Wolfe has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Cartesian. Dr. Wolfe has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Grifols. The institution of Dr. Wolfe has received research support from UCB/Ra. The institution of Dr. Wolfe has received research support from Immunovant. The institution of Dr. Wolfe has received research support from Roche. Dr. Wolfe has received personal compensation in the range of $0-$499 for serving as a Advisor with FDA Advisory Panel for Cellular, Tissue and Genetic Therapies.

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