Telitacicept as an alternative to non-steroidal immunosuppressive therapies in the treatment of myasthenia gravis: a study on clinical efficacy and steroid-sparing effect

Abstract

Introduction: Myasthenia Gravis (MG) is an autoimmune disorder characterized by impaired neuromuscular junction (NMJ) transmission. Current treatments for MG include steroids and nonsteroidal immunosuppressive therapies (NSISTs). However, approximately 20% of patients show a poor response to these therapies, which are often associated with significant side effects. Telitacicept, a novel recombinant fusion protein targeting the BAFF/APRIL pathway, has shown promise in treating autoimmune diseases, including MG.

Methods: This retrospective study compared the efficacy of telitacicept monotherapy (10 patients) to NSISTs (16 patients) and sequential therapy (6 patients) in managing Myasthenia Gravis (MG) at The First Affiliated Hospital of Wenzhou Medical University (July 2020-November 2024). The primary endpoint was the time to achieve minimal symptom expression (MSE), and secondary endpoint was the change in the mean daily prednisone dosage from baseline to month 4.

Results: Among telitacicept-treated patients, 80% achieved MSE within 4 months, with a significant reduction in mean daily dose of prednisone (from 45.00 mg to 6.25 mg, P < 0.001). In contrast, only 12.5% of the NSISTs group achieved MSE, with no significant change in mean daily dose of prednisone (P = 0.091). The sequential therapy group (efgartigimod followed by telitacicept) maintained stable disease conditions.

Conclusion: Telitacicept is effective in inducing MSE rapidly and offers a steroid-sparing effect, making it a promising alternative to traditional NSISTs with fewer side effects in MG patients.

Keywords: minimal symptom expression; myasthenia gravis; non-steroidal immunosuppressive therapies; steroid-sparing; telitacicept.

Figure 1

Clinical outcomes following telitacicept treatment in MG. (A) Kaplan-Meier survival curve illustrating the probability of not achieving MSE over a 5-month period. (B) The proportion of the 5-month period during which each patient was in MSE. (C) Individual MG-ADL scores and time to MSE. (D) Mean daily prednisone dose at baseline, 2 months, and 4 months.

Figure 2

Stability of MG in patients treated with sequential therapy of efgartigimod and telitacicept. (A) MG-ADL scores at weeks 4, 5, 6, 7, 9, 11, 13, 17, and 21. (B) A reduction in mean daily prednisone dosage was observed in patients undergoing sequential therapy at the 16-week follow-up. (C) Comparison of mean daily prednisone dose at week 4 and week 16.

Figure 3

Telitacicept achieves MSE more rapidly and with greater steroid-sparing effects compared to NSISTs. (A) Distribution and prevalence of immunosuppressive agents and telitacicept. (B) Individual MG-ADL scores for NSISTs group patients at baseline, 2 months, and 4 months. (C) Cox regression for time to achieve MSE. (D) Percentage of patients achieving MSE at 3 and 4 months. (E) Mean daily prednisone dose for NSISTs group patients at baseline, 2 months, and 4 months.