Rescue Treatment of Inebilizumab in Refractory Myasthenia Gravis: A Case Report
Qilong Jiang1, Liqing Hu1, Chaoyue Zhang1, Yufei Deng1, HAOCHENG LUO1, Xiaojun Yang1, Li Yang1
1The First Affiliated Hospital of Guangzhou University of Chinese Medicine
Objective:
To report the efficacy and safety of the first rescue treatment of refractory myasthenia gravis patient with Inebilizumab (CD19 monoclonal antibody).
Background:
Refractory myasthenia gravis (MG) is defined as an inadequate response to at least two traditional immunotherapy treatments or other biologics, and patients may still experience recurrent crises, lacking safe and effective treatment options.
Design/Methods:
A 55-year-old male patient with acetylcholine receptor antibody-positive myasthenia gravis (MG) and a 5-year disease course underwent thymectomy in 2021 (pathology: type B2), with no significant myasthenic symptoms. In 2024, he developed bulbar muscle symptoms and progressed to myasthenic crisis twice. He received sequential treatments including plasmapheresis, intravenous immunoglobulin (IVIG) pulse therapy, efgartigimod, and telitacicept, all with suboptimal responses. The patient continued to experience recurrent crises and difficulty in weaning from respirator. In June 2024, after two courses of eculizumab combined with telitacicept, he was successfully extubated and discharged. In April 2025, he experienced another crisis (QMG score: 28, MG-ADL score: 18). Both glucocorticoid pulse therapy and eculizumab treatment proved ineffective. Subsequently, he received inebilizumab 300 mg on July 18, 2025, and August 1, 2025.
Results:
After 8 weeks of inebilizumab treatment, the QMG score decreased to 21(from 28) and the MG-ADL score to 13(from 18), with obvious improvement in respiratory and limb muscle strength. The patient achieved over 10 hours of daytime ventilator-free periods with nocturnal low-flow oxygen therapy. Only one mild upper respiratory tract infection occurred during treatment.
Conclusions:
Inebilizumab demonstrates rapid and sustained clinical improvement in refractory myasthenia gravis with a favorable tolerability profile, worth further validation in larger cohorts.
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