Intravenous Human IgG1 Fc Fragment (Efgartigimod) in Myasthenic Crisis

NCT06688253 | Not Yet Recruiting Phase 4 FDA Drug

• 1 other identifier: rambam271
• Study Type: interventional
• Target: 16
• Locations: 1 country
• Sites: 1

Brief Summary

Efgartigimod in Myasthenic Crisis Background Myasthenia gravis (MG) is a prevalent autoimmune disorder affecting neuromuscular junctions, characterized by weakness in skeletal muscles. It is associated with the production of autoantibodies, primarily targeting acetylcholine receptors (AchR), and is often complicated by myasthenic crisis, which can lead to severe respiratory failure. Current treatments primarily involve non-specific immunosuppression, which may not provide rapid relief. Aim This study investigates the therapeutic impact of efgartigimod, an FcRn-targeting Fc fragment, on patients experiencing a myasthenic crisis. We hypothesize that efgartigimod is non-inferior to conventional treatments like intravenous immunoglobulin (IVIG) and plasma exchange (PLEX) in terms of clinical efficacy and safety. Study Rationale Efgartigimod aims to reduce pathogenic IgG autoantibodies implicated in MG by accelerating their degradation. This targeted approach could provide faster symptom relief during acute exacerbations compared to existing therapies. Objectives Primary Objective: To assess the non-inferiority of efgartigimod compared to PLEX and IVIG based on MG-ADL improvements. Secondary Objectives: Evaluate safety, tolerability, length of hospital stay, respiratory parameters, need for additional therapies, and one-year outcomes. Primary Endpoint MG-ADL Improvement: Defined as a ≥3-point improvement post-treatment. The comparison will be made using one-month post-treatment assessments, with follow-ups every three months. Secondary Endpoints Safety and tolerability Length of hospital stay Changes in respiratory function Need for rescue therapy in case of clinical deterioration Sample Size The study will recruit 32 patients (16 historical group and 16 interventional group), calculated to detect significant differences in MG-ADL improvements with a significance level of 0.05 and power of 0.80. Patient Recruitment Patients with a confirmed diagnosis of MG who present to the neurology department will be recruited and randomly assigned to either the efgartigimod treatment group or the historical control group receiving standard care (IVIG/PLEX). Inclusion Criteria Adults \> 18 years Confirmed MG diagnosis with generalized weakness (MGFA class II-V) Positive AchR or MuSK antibodies Evidence of myasthenic crisis Informed consent Exclusion Criteria Contraindications to efgartigimod Significant comorbidities affecting study participation Prior exposure to efgartigimod Ongoing infections or conditions exacerbating MG symptoms Recent major surgery or significant renal/hepatic dysfunction Planned Protocol Administer efgartigimod intravenously at 10 mg/kg weekly for four weeks. Total trial duration: 12 months for enrollment and treatment, followed by a 14-month follow-up.

Conditions

Myasthenia Gravis Crisis

Keywords

Myasthenia Gravis Crisis

Outcome Measures

Primary Outcomes (1)

• MG-ADL scores observed before and after treatment initiation

  Descriptive statistics will be used to summarize the characteristics of the study population. Kaplan-Meier curves to estimate the probability of cancer over time in cumulative analysis curves. A two-tailed p-value \<0.05 was considered statistically significant

  14 month

Study Arms (2)

Interventional group with Efgartigimod

EXPERIMENTAL

Efgartigimod will be given to patients with MG CRISIS

Drug: IV efgartigimod

Historical PLEX group

NO INTERVENTION

this group is the retrospective arm

Interventions

IV efgartigimod DRUG

IV efgartigimod

Also known as: vyvgart

Interventional group with Efgartigimod

Eligibility Criteria

• Age: 18 Years - 99 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age \> 18
• MG diagnosis
• A confirmed diagnosis of Myasthenia Gravis (MG) with generalized muscle weakness, classified as MGFA class II, III, IVa, or IVb and V.
• Positive AchR or MuSK antibodies (max three patients of the total cohort) this will be tested in our center for all patients.
• Myasthenic crisis: Worsening of \> 3 or an increase \>1 MG-ADL points of a sub score of any individual MG-ADL item other than double vision or eyelid droop and its clinically significant by the investigator. Alternatively, weakness related to MG that is severe enough to necessitate intubation or delay Ex-tubation following surgery.
• Willingness to provide informed consent.

You may not qualify if:

• Other significant medical conditions that may interfere with study participation.
• Prior exposure to Efgartigimod.
• Male patients who do not intend to use effective contraception during trail or within last dosing
• Pateints with worsening muscle weekness due to concurrent infection or medications known to exacerbate MG.
• Patients with known or active seropositive HBV,HCV, HIV.
• Patients with documented lack of clinical response to Flax.
• Use of any investigational drug within 3 month or 5 helf -lives prior to screening.
• Avidance of significant disease ,recent major surgery or renal/ hepatic function who can put patient at undue risk.
• Previous participation in clinic trail involving ARGX-113
• Vaccination recived whitin 4 weeks prior screening using live or attenuated vaccinations.
• Patient Calssified MGFA Class 1
• Pregnant and lactating women

Sponsors & Collaborators

• Rambam Health Care Campus: lead
• argenx: collaborator

Study Sites (1)

Rambam- Department of Neurology

Haifa, 3109601, Israel

Location

MeSH Terms

Interventions

efgartigimod alfa

Central Study Contacts

Shahar Shelly, Dr

CONTACT

+972543541995; s_shelly@rambam.health.gov.il

Chen Tikotzki

CONTACT

+972544833981; C_TIKOTZKI@rambam.health.gov.il

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Specialist in Neurology and Immunology

Study Record Dates

• First Submitted: November 5, 2024
• First Posted: November 14, 2024
• Study Start: November 15, 2024
• Primary Completion: January 15, 2025
• Study Completion: March 30, 2025
• Last Updated: November 14, 2024

Record last verified: 2024-11

Data Sharing

• IPD Sharing: Will not share

Locations

IL (1)