This study aims to assess whether efgartigimod can alleviate myasthenia gravis (MG) symptoms during the perioperative period of thymectomy and decrease the incidence of postoperative myasthenic crisis.

This study collected 16 MGFA IIIb+ cases (7M, 9F) from Jan-Sep 2024. All were ADL ≥5 after immunosuppressive treatment. They received weekly efgartigimod (10 mg/kg/cycle, every 4 weeks). ADL scores were reassessed 3 days post-dose. ≥2-point reduction post-treatment indicated response. Thymectomy followed 1-4 weeks later.

Among 16 patients, 13 had robot-assisted subxiphoid thymectomy, 2 had left thoracic thymectomy, and 1 with recurrent thymoma had median sternotomy. 13 patients (81.25%) responded (ADL ≥2 points); 5 males, 8 females; 8 with thymoma, 5 with recurrent thymoma. All were AChR antibody positive, aged 60.3±14.7 years (32-89). Pretreatment ADL score was 7.4±3.1, presurgery was 3.2±2.1.

Postoperatively, 3 patients (18.75%) had myasthenic crisis with delayed extubation (3.3±2.7 days). 2 patients (12.5%) required non-invasive ventilation postoperatively (4.5±3.4 days). An 89-year-old female with thymoma and multiple comorbidities developed diarrhea, UTIs, respiratory infections, and failure postoperatively. She was reintubated on POD 21, and died of multiple organ failure on POD 43. The other 15 patients (93.75%) were discharged, with ICU stay of 2.1±1.9 days and hospital stay of 7.4±2.2 days.

Our clinical experience shows that efgartigimod can improve myasthenia gravis symptoms during the perioperative period and reduce the incidence of postoperative myasthenic crisis for high-risk patients undergoing thymectomy. However, more clinical studies are needed to analyze surgical indications, timing, and perioperative comprehensive treatment processes.