Treatment of Myasthenia Gravis Exacerbation or Crisis With Efgartigimod: A Single Arm, Open Label Prospective Cohort Study
试验速览
- 阶段
- 4 期
- 状态
- 招募中
- 入组人数
- 20
- 试验地点
- 1
- 主要终点
- Change from baseline in the Quantitative Myasthenia Gravis (QMG) score at day 11
研究概览
简要总结
This study plans to learn more about if the drug efgartigimod can be used in the hospital to treat exacerbations in participants with myasthenia gravis (MG). Efgartigimod has been approved by the FDA for ongoing (chronic) treatment of generalized MG in adult patients who are anti-acetylcholine receptor (AChR) antibody positive but has not been studied in the treatment of worsening weakness requiring hospital admission (known as "exacerbation"). This investigation aims to see if using efgartigimod in this way improves symptoms and recovery from exacerbation, and how it affects certain MG markers in the blood. The main questions it aims to answer are:
- Is efgartigimod effective as a hospital-administered acute therapy for participants with worsening MG (MG exacerbation) who require hospitalization?
- Will efgartigimod lead to clinical improvement with a similar reduction in validated research scales, such as the Quantitative MG (QMG) scale, as standard of care therapies?
Participants will receive 4 doses of efgartigimod over the course of 4 weeks with an additional follow-up visit at the clinic.
详细描述
Efgartigimod is thought to work by reducing circulating IgG antibodies, including the antibodies that cause MG. One of the currently used treatments for MG exacerbation, called plasma exchange (PLEX), is also thought to work by reducing antibody levels by filtering blood through a machine similar to those used in dialysis for kidney failure. Because of the similarities between how these two treatments work, there is reason to believe that efgartigimod may also be helpful in treating MG exacerbation.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adults ≥ age 18 years with known generalized MG as identified by characteristic signs of generalized MG on clinical assessment and positive serology for AchR antibodies as well as one of the following:
- •Documented positive response to cholinesterase inhibitors such as pyridostigmine or edrophonium
- •Abnormal decrement on slow repetitive nerve stimulation testing
- •Abnormal single fiber EMG
- •Evidence of worsening weakness requiring hospital admission for stabilization and change in therapy as determined by a neuromuscular expert including:
- •Quantitative Myasthenia Gravis (QMG) scale ≥ 11
- •MG-ADL score ≥ 6
- •Worsening weakness that is unlikely to be ameliorated by adjustment of current medications including impaired respiratory status, dysarthria, dysphagia, difficulty chewing, limb weakness, diplopia, ptosis.
- •Ability to sign consent and be enrolled within 24 hours of hospital admission. For participants transferred to University of Colorado Hospital, the time of admission/presentation to the outside hospital is counted towards this 24-hour cap.
排除标准
- •MG worsening thought to be related to active infection or due to medications (e.g. fluoroquinolone or aminoglycoside antibiotics, magnesium, chloroquine derivatives)
- •Intubation prior to ability to sign informed consent or intubation within 24 hours of hospitalization
- •Use of IVIG within 2 weeks, or having undergone plasma exchange or received efgartigimod in the 4 weeks prior to admission
- •Current ongoing use of ravulizumab or eculizumab (monoclonal antibody C5-complement inhibitors).
- •Other medical conditions that, in the opinion of the investigator and treating clinicians, might interfere with the validity of assessment measures used in the study (e.g. steroid myopathy, CNS pathology, severe arthritis, fractures, etc.). This criterion is a standard exclusion in MG trials and relates solely to other conditions that reduce muscle power or range of motion and would thus worsen scores on assessment measures like the QMG due to non-MG conditions.
- •Known history of coagulopathy, blood clotting, recent severe bleeding (e.g. GI bleed).
- •Pregnancy or breastfeeding. Pregnancy must be excluded for all potential participants who are able to become pregnant prior to initiation of treatment.
- •IgG levels < 600mg/dL
- •Evidence of active or chronic Hepatitis B infection, untreated Hepatitis C infection, HIV with low CD4 (<200) count.
研究组 & 干预措施
Efgartigimod
Participants receive 4 doses of efgartigimod via intravenous (IV) infusion over the course of the study on days 1, 4, 11 and 18.
干预措施: Efgartigimod (Drug)
结局指标
主要结局
Change from baseline in the Quantitative Myasthenia Gravis (QMG) score at day 11
时间窗: Baseline, Day 11
The Quantitative Myasthenia Gravis (QMG) is a scoring system that quantifies disease severity by measuring ocular, bulbar, respiratory and limb strength. The total scores range from 0 to 39, with higher scores indicating greater disease severity.
次要结局
- Percentage of participants requiring rescue therapy with Plasma Exchange (PLEX) or Intravenous Immunoglobulin (IVIG)(During hospitalization, approximately 7 days)
- Change from baseline in Myasthenia Gravis Activities of Daily Life (MG-ADL) scale at day 18(Baseline, Day 18)
- Change from baseline in Myasthenia Gravis Activities of Daily Life (MG-ADL) scale at day 32(Baseline, Day 32)
- Change from baseline in Myasthenia Gravis Manual Muscle Test (MG-MMT) at day 32(Baseline, Day 32)
- Change from baseline in Myasthenia Gravis Manual Muscle Test (MG-MMT) at day 11(Baseline, Day 11)
- Change from baseline in Myasthenia Gravis Manual Muscle Test (MG-MMT) at day 18(Baseline, Day 18)
- Change from baseline in Myasthenia Gravis Quality of Life-15 Revised (MG-QOL15r) at day 18(Baseline, Day 18)
- Change from baseline in Myasthenia Gravis Quality of Life-15 Revised (MG-QOL15r) at day 32(Baseline, Day 32)
- Postinterventional status at day 32(Day 32)
- Change from baseline in the Quantitative Myasthenia Gravis (QMG) score at day 4(Baseline, Day 4)
- Change from baseline in the Quantitative Myasthenia Gravis (QMG) score at day 32(Baseline, Day 32)
- Postinterventional status at day 11(Day 11)
- Postinterventional status at day 18(Day 18)
- Length of hospital stay(Duration of hospitalization, approximately 7 days)
- Proportion of participants requiring mechanical ventilation(During hospitalization, approximately 7 days)
- Proportion of participants requiring enteral feeding(During hospitalization, approximately 7 days)
- Time to freedom from respiratory support(During hospitalization, approximately 7 days)
- Change from baseline in Total Immunoglobin G (IgG) at day 32(Baseline, Day 32)
- Change from baseline in Acetylcholine Receptor (AchR) antibody titer at day 32(Baseline, Day 32)