This study examined the effect of ravulizumab and efgartigimod on various functional scales, including Myasthenia Gravis Activities of Daily Living (MG-ADL) and Quantitative Myasthenia Gravis (QMG).

Biological therapies that target the antibodies and interfere with their functions, such as the complement inhibitor (ravulizumab) or the neonatal FC receptor agonist (efgartigimod), have been recently approved for Acetylcholine receptor (AChR)-AB positive myasthenia gravis (MG), but their comparative effects on the functional scales are lacking.

A comprehensive literature search and analysis of PubMed, Google Scholar, and Scopus were conducted from January 1, 2015, to October 10, 2025. Each research study that evaluated the effects of ravulizumab and efgartigimod on different functional scales has been collected. RevMan software conducted a meta-analysis, and the effect size with subgroup analysis has been computed.

Three studies have been identified, all of which are randomized controlled trials. Functional scales were compared at the baseline and at 26 weeks of treatment. 

One hundred twenty-seven patients received ravulizumab, while 76 patients received efgartigimod.

The overall mean difference among both medications was MD -2.0 (95% CI -1.59 to 1.2), P<0.78). Upon further subgroup analysis, the mean difference for the effect on MG-ADL and QMG was (MD=0.26, 95% CI -1.35 to 1.98, P=0.76) and (MD=-1.11, 95% CI -3.52 to 1.30, P=0.37), respectively.

Although there is some evidence that efgartigimod provides rapid improvement, there is no difference among the medications in the longer duration. A further head-to-head trial is needed with a longer duration.