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0 reviewsA B S T R A C TKeywords:Early intervention in impending myasthenic crisis (IMC) is critical to avert life-threatening progression. ThisMyasthenia gravisstudy compared the clinical effectiveness and safety of the novel FcRn antagonist efgartigimod versus intraveImpending myasthenic crisisnous immunoglobulin (IVIg) in IMC management. In this retrospective cohort study, we analyzed 51 acetylEfgartigimodcholine receptor antibody-positive (AChR-Ab+) IMC patients who received either efgartigimod (n = 30) or IVIgIntravenous immunoglobulin(n = 21) from June 2023 to November 2024. Efficacy was assessed based on changes in Myasthenia GravisEfficacyActivities of Daily Living (MG-ADL) and Quantitative Myasthenia Gravis (QMG) scores over four weeks. Fromweeks 2–4, the efgartigimod group showed significantly greater improvements in MG-ADL and QMG scores (bothP < 0.05), with a similar trend after baseline adjustment. By week 4, the results of the clinically meaningfulimprovement (CMI) analysis indicated that a higher proportion of patients in the efgartigimod group achievedMG-ADL improvement ≥7 points (90.0 % vs. 57.1 %) and greater QMG scores improvement. The proportion ofpatients reaching minimal symptom expression (MSE) was 80.0 % in the efgartigimod group compared to 14.3 %in the IVIg group, with mean improvement rates of 91.5 % vs. 60.7 %, respectively. One case of myastheniccrisis-related death occurred in the IVIg group, while no severe adverse events were reported in the remainingpatients. Efgartigimod has been shown to effectively alleviate IMC symptoms, prevent progression to myastheniccrisis (MC), and significantly reduce in complications without substantially increasing the economic costs. Thesefindings suggest its potential as a first-line therapeutic option for AChR-Ab-positive IMC patients.