Efgartigimod Shows Non-Inferior Disability Improvement and Greater Muscle Strength Recovery Versus Plasma Exchange in Real-World GBS Study

A real-world comparative study of efgartigimod alfa (Vyvgart; argenx) versus plasma exchange (PE) in patients with Guillain-Barre syndrome (GBS) was among the abstracts featured at the 2026 Peripheral Nerve Society (PNS) Annual Meeting in Maastricht, Netherlands.¹ Overall, the study found that while short-term disability improvement was similar between treatment groups, efgartigimod produced significantly greater muscle strength recovery at weeks 8 and 12, supporting its potential as an alternative to PE in this setting.

Study Design

Presented by Yuzhong Wang of the Affiliated Hospital of Jining Medical University in Jining, China, the study enrolled 35 adults with GBS who received either intravenous efgartigimod (10 mg/kg weekly for 2 doses; n = 15) or standard PE (5 exchanges; n = 20). Baseline characteristics were comparable between groups. The primary outcome was change in GBS disability score (GBS-DS) at 4 weeks. Secondary outcomes included MRC sum score, time to independent ambulation (GBS-DS of 2 or less), and safety.

The study follows a growing body of case-based and retrospective evidence examining efgartigimod in GBS, a setting where IVIg and PE remain the only standard first-line therapies but where approximately 20% of patients are left with substantial residual disability following either treatment.²

Key Findings

At 4 weeks, improvement in GBS-DS was similar between the efgartigimod and PE groups, with a median change of −1 point for both (P = .476). However, efgartigimod led to significantly greater muscle strength recovery at weeks 8 and 12, as measured by median MRC sum score improvement: 16 versus 8 points at week 8 (P = .029) and 22 versus 8 points at week 12 (P = .015).¹

Treatment with efgartigimod also induced a rapid, sustained reduction of more than 60% in serum total IgG, consistent with its mechanism as an FcRn inhibitor that accelerates IgG degradation. Major adverse event rates were similar between groups.¹

Investigators concluded that efgartigimod demonstrated disability improvement non-inferior to PE, with superior recovery of muscle strength at later time points. They noted that the targeted mechanism and acceptable safety profile support its potential as a new therapeutic alternative in GBS, warranting further randomized controlled trials.

Contextualizing the Evidence

Interest in efgartigimod as a GBS treatment has grown substantially since early case reports. A 2024 case series published in the Journal of Neurology by Zhang et al. described two patients with GBS who received intravenous efgartigimod and showed rapid motor function improvement within 4 weeks, representing the first report of GBS treatment with the agent.³ A March 2026 retrospective analysis published in Scientific Reports by Cheng,

Wang, and colleagues compared efgartigimod to both IVIg and PE in 17 patients, finding significantly shorter time to a 1-point GBS-DS improvement with efgartigimod versus IVIg (median 4.0 vs 7.0 days; P = .033), along with higher proportions achieving INCAT scores of 2 or less at week 1 (80% vs 12.5% [IVIg], 25% [PE]; P = .039).⁴

Taken together, the PNS abstract and these earlier datasets represent a nascent but converging signal that efgartigimod may offer faster onset of IgG reduction and functional recovery than conventional therapies in GBS. Efgartigimod is not currently approved for GBS; it carries FDA approval for generalized myasthenia gravis and CIDP.

Limitations

This was a small real-world study without randomization, and the sample sizes limit statistical power for subgroup analyses. Direct comparisons with IVIg were not included in this abstract. The authors called for prospective randomized controlled trials to validate the findings.

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REFERENCES
1. Zhang L, Qi F, Hu M, Chen Y, Song Y, Wang Y. Efgartigimod versus plasma exchange in Guillain-Barre syndrome: a real-world comparative efficacy and safety study. Abstract submitted to: Peripheral Nerve Society Annual Meeting; 2026; Maastricht, Netherlands. Abstract P 245.
2. van der Meche FG, Schmitz PI; Dutch Guillain-Barre Study Group. A randomized trial comparing intravenous immune globulin and plasma exchange in Guillain-Barre syndrome. N Engl J Med. 1992;326(17):1123-1129. doi:10.1056/NEJM199204233261705. https://doi.org/10.1056/NEJM199204233261705
3. Zhang H, Ma J, Feng Y, et al. Efgartigimod in the treatment of Guillain-Barre syndrome. J Neurol. 2024;271(6):3506-3511. doi:10.1007/s00415-024-12321-4. https://doi.org/10.1007/s00415-024-12321-4
4. Cheng Y, Li W, Xie S, et al. Rapid neurological recovery in Guillain-Barre syndrome treated with efgartigimod. Sci Rep. 2026;16:14128. doi:10.1038/s41598-026-44163-7. https://doi.org/10.1038/s41598-026-44163-7