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1. A 47-year-old woman with AChR-Ab+ gMG has been on prednisone 20 mg/day for 3 years plus monthly IVIg. Her MG-ADL is 4, and she has gained weight and has insomnia. She is asking about B-cell–directed options. Which statement is best supported by randomized trial evidence?
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Rituximab met its steroid-sparing primary endpoint in the phase 2 BeatMG Trial in AChR-Ab+ gMG
The BAFF-only inhibitor belimumab significantly improved QMG vs placebo at 24 weeks
Inebilizumab significantly improved MG-ADL vs placebo at week 26 in a combined AChR-Ab+/MuSK-Ab+ population
Her MG-ADL of 4 means she has reached the minimal symptom expression (MSE) target, so no change is needed
2. Which statement best describes telitacicept?
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A TACI-Fc fusion protein that neutralizes both BAFF and APRIL. In a phase 3 trial in China, it produced a greater mean MG-ADL improvement than placebo at week 24 (−6.4 vs −1.6).
An anti-CD19 monoclonal antibody that depletes B cells through ADCC. In phase 3, it was given IV every 6 months after loading doses.
An FcRn blocker that speeds up IgG breakdown. In phase 3, it cut IgG by more than 70% within the first week.
A selective BAFF-only inhibitor. BAFF blockade alone met its primary endpoint in a randomized phase 2 gMG trial.
3. A 38-year-old woman with MuSK-Ab+ gMG responded to rituximab in the past. She now has recurring dysphagia and dysarthria, with an MG-ADL of 7. Which plan is most appropriate?
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Start a complement C5 inhibitor for fast control of bulbar symptoms
Use a fast IgG-lowering approach (e.g., an FcRn inhibitor) plus B-cell/plasma-cell–directed therapy for lasting control, and consider BAFF/APRIL inhibition through a clinical trial
Raise pyridostigmine to the maximum tolerated dose as her only therapy
Continue her current management and reassess in 6 months, given her past rituximab response
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