Real-World Experience With Efgartigimod in CIDP

Body text: As new therapies enter clinical practice, the questions clinicians ask often shift from whether a treatment works to how it can be used most effectively in the patients they see every day. For chronic inflammatory demyelinating polyneuropathy, growing real-world experience with efgartigimod is beginning to provide insights that extend beyond the original clinical trial data.

In this NeurologyLive® Special Report, Karissa Gable, MD, FAAN, professor of neurology at Duke University, and Jeffrey Allen, MD, associate professor of neurology at the University of Minnesota, discuss the evolving role of subcutaneous efgartigimod PH20 (Vyvgart Hytrulo) in CIDP management. While the broader series focuses on findings from the ADHERE and ADHERE+ post hoc analysis, the discussion also examines how those data are informing treatment decisions in routine clinical practice.

In this episode, the conversation shifts from trial outcomes to real-world application. Allen reflects on what clinicians have learned since efgartigimod received approval for CIDP, including which patients may derive the greatest benefit, considerations when transitioning from immunoglobulin therapy, and the unanswered questions that ongoing research may help address.

Jeffrey Allen, MD:

I think we've learned that it's a very good treatment option for some patients with CIDP. We've also learned that it isn't the right treatment for every patient, but I think you could say that about essentially every therapy we use in CIDP because the disease itself is so heterogeneous. We still haven't found a single treatment that's going to work for everyone.

Efgartigimod now falls into the category of an evidence-based therapy that has been shown to be effective for preventing relapse and, in some patients, improving disability. One of our biggest challenges is identifying which patients are the best candidates for treatment. I think patients who respond to traditional therapies such as immunoglobulin, but struggle with the logistics or tolerability of frequent intravenous infusions, may be particularly good candidates for an FcRn antagonist like efgartigimod.

There have been reports of patients who transition from immunoglobulin to an FcRn antagonist and experience worsening. I think those cases are uncommon, but they are real, and they reinforce the importance of monitoring patients closely during those first several weeks after transitioning therapy.

We still need to better understand how to transition patients from immunoglobulin to efgartigimod. An ongoing switching study should provide additional information on the optimal timing of that transition and whether certain patients may be at higher risk for worsening. Those are important questions that we still need to answer.

Overall, I think efgartigimod is an excellent treatment option, particularly for patients with well-defined CIDP who have responded to traditional therapies but are looking for an option that may be more convenient or better tolerated.