Have you found FcRn inhibitors effective for weaning off or replacing IVIG for the treatment of refractory seropositive myasthenia gravis?
E.g., rozanolixizumab, efgartigimod. How long do you wait after stopping IVIG before starting?
Answer from: at Academic Institution
I think efgartigimod can be considered as an alternative to IVIG in sero-positive generalized MG, especially in patients who experience severe side effects from IVIG or contraindications due to cardiac, renal dysfunction or clotting disorder.One of the proposed mechanisms of IVIG is by overwhelming ...
I have found, in my clinical practice, that the FcRn inhibitors are effective for replacing IVIG. As there are no readily available transition guides to assist in the transition from IVIG to FcRn inhibitors, I typically arrange for the FcRn inhibitor (such as efgartigimod) to occur at the time of th...
In my practice, FcRn inhibitors have largely replaced IVIg, for several reasons:
They have been approved for use in AChR and MuSK antibody-positive generalized myasthenia, whereas IVIg is not; this makes insurance authorization easier.
I can still use them cyclically, in a similar way to IVIg.
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The use of long-term maintenance IVIg, as opposed to acute treatment of impending or manifest myasthenic crisis where it is standard of care, is relatively common in clinical practice in the management of refractory MG with variable efficacy. IVIg is associated with certain side effects, including t...