Objective of our study is to describe the differential response of innovative treatments on subscores of the Myasthenia Graves activities of daily living (MG-ADL), and quantitative MG scale (QMG) in a real-life setting.

We included patients receiving either ECU or EFGA as part of our clinic practice and retrospectively collected data on the MG-ADL and QMG. We limited the observation of the MG-ADL to weekly scores for the first 8 weeks of treatment, and of the QMG at baseline and after 5, 12, 24, 36, and 48 weeks. We analyzed the difference between treatments with a General Linear Model for repeated measures. 

We enrolled 38 patients, 22 treated with ECU and 16 with EFGA. Median follow-up was 321 days. We found a higher response to Eculizumab at the MG-ADL, with a significant difference at week 7 (-6.3 vs 3.8; p=0.038). We found a higher response to Eculizumab at the QMG  at week 24 (-6.0 vs -0.9; p=0.032), 36 (-7.7 vs -1.7; p=0.020), and 48 (-8.5 vs -2.6; p=0.018).

We found no difference at the MG-ADL for the ocular (F=1.468, p=0.204) and limb subscores (F=0.909, p=0.408), and at the QMG for ocular (F=0.284, p=0.888) and limb subscores (F=1.527, p=0.229). 

Impact on bulbar subscores was higher for Eculizaumab at the MG-ADL at week 6 (-3-4 vs -1.2, p=0.009) and 7 (-3.1 vs -1.2, p=0.020), and for Eculizumab at the QMG at week 12 (-2.1 vs -.8, p=0.025) and 36 (-3.0 vs -1.1, p=0.018). Mean QMG score for the forced vital capacity (FVC) decreased more with Eculizumab throughout the entire observation period (F=3.287, p=0.036).

Our study shows a differential effect of Eculizumab and Efgartigimod on the MG-ADL and QMG with a deeper effect of Eculizumab on bulbar scores.