The primary efficacy end point for this study was the percent of patients achieving a 50% or greater reduction in CS dose at week 39 from baseline (week 0). Secondary efficacy end points measured from baseline (week 0) to week 39 were the percent reduction in CS daily dose and the time to the first episode of MG worsening (as defined above).
Exploratory end points related to CS therapy included the following: percent of patients achieving a ≥75% reduction in CS dose at week 39, percent of patients achieving a CS dose ≤7.5 mg (prednisone equivalent) at week 39, percent of patients CS-free at week 39, change in fasting serum glucose at week 39 vs baseline, percent of patients with fasting glucose ≤125 mg/dL at week 39 vs baseline, and a change in hemoglobin A1c at week 39 compared with baseline (week 0).
Exploratory end points related to MG were as follows: percent of patients experiencing an MC or worsening of MG requiring hospitalization through week 39 and week 39 through week 45, number of episodes of MG worsening from baseline (week 0) to week 39, changes in a 15-item MG-Quality of Life Instrument (MG-QOL 15) at weeks 39, 42, and 45 compared with baseline (week 0), changes in MG-Activities of Daily Living (MG-ADL) score at weeks 39, 42, and 45 from baseline (week 0), and changes from baseline (week 0) in the activity (binding, blocking, and modulating) of anti-acetylcholine receptor antibodies at week 39 (Covance Central Laboratory, Indianapolis, IN). In addition, the change in serum IgG levels from baseline (week 0) was measured at weeks 9, 24, and 39.
The guide for CS taper was the QMG score.
17 (link) A 3-point improvement in the QMG score reflects a clinically significant improvement.
19 (link) Study patients taking cholinesterase inhibitors were instructed not to take these medications for 12 hours before QMG testing. The MG-QOL 15 is a measure of mobility, symptoms, general contentment, and emotional well-being as assessed by the patient.
20 (link)- (link)22 (link) The MG-ADL score is designed to assess the effects of MG on usual daily activities. A 2-point improvement in MG-ADL was designated as clinically significant.
23 (link) The MG Composite scale has been recommended by the MGFA as a quantitative measure for patients with generalized MG.
24 (link),25 (link) A 3-point improvement in the MG Composite was correlated with clinical improvement and meaningful improvement to patients.
26 (link)
Bril V., Szczudlik A., Vaitkus A., Rozsa C., Kostera-Pruszczyk A., Hon P., Bednarik J., Tyblova M., Köhler W., Toomsoo T., Nowak R.J., Mozaffar T., Freimer M.L., Nicolle M.W., Magnus T., Pulley M.T., Rivner M., Dimachkie M.M., Distad B.J., Pascuzzi R.M., Babiar D., Lin J., Querolt Coll M., Griffin R, & Mondou E. (2023). Randomized Double-Blind Placebo-Controlled Trial of the Corticosteroid-Sparing Effects of Immunoglobulin in Myasthenia Gravis. Neurology, 100(7), e671-e682.