Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
Patient leaflets and SmPCs, drug interaction checker, official dosages and NHS pharmacy opening hours — all in one place.
The electronic medicines compendium (emc) no longer publishes a Summary of Product Characteristics for this product, which usually means it is no longer marketed in the UK. The patient leaflet below is kept for reference, but the product may not be available.
If you were prescribed this medicine, other products containing Efgartigimod alfa may still be available. Do not stop your treatment — ask your pharmacist or GP what to use instead.
for
What Vyvgart is Vyvgart contains the active substance efgartigimod alfa. Efgartigimod alfa binds to and blocks a protein in the body called neonatal Fc receptor (FcRn). By blocking FcRn, efgartigimod alfa decreases the level of immunoglobulin G (IgG) autoantibodies which are proteins of the immune system that attack parts of a person's own body by mistake. What Vyvgart is used for Vyvgart is used together with standard therapy to treat adults with generalised Myasthenia Gravis (gMG), an autoimmune disease that causes muscle weakness. gMG can affect multiple muscle groups throughout the body. The condition can also lead to shortness of breath, extreme fatigue and difficulties swallowing. In patients with gMG, IgG autoantibodies attack and damage proteins on nerves called acetylcholine receptors. Because of this damage, the nerves are not able to make the muscles contract as well as normal, leading to muscle weakness and difficulty moving. By binding to the FcRn protein and reducing autoantibody levels, Vyvgart can improve the ability of muscles to contract and reduce the symptoms of the disease and their impact on daily activities. Vyvgart is also used to treat adults with chronic inflammatory demyelinating polyneuropathy (CIDP), a form of autoimmune disease. CIDP causes muscle weakness and/or numbness mainly in the legs and arms. Vyvgart can protect the nerves from being attacked and reduce the symptoms of the disease and their impact on daily activities.
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e Vyvgart
Do not use Vyvgart if you are allergic to efgartigimod alfa or any of the other ingredients of this medicine (listed in section 6). Warnings and precautions Talk to your doctor before using Vyvgart. MGFA class V Your doctor may not prescribe this medicine if you are on a ventilator due to gMG muscle weakness (myasthenic crisis). Infections Vyvgart treatment may reduce your natural resistance to infections. Therefore, before starting Vyvgart, inform your doctor if you have any infections. Injection reactions and allergic reactions Vyvgart contains a protein that can cause reactions such as rash or itching in some people. Vyvgart may cause anaphylactic reaction (a serious allergic reaction). If you experience allergic reactions such as swelling of the face, lips, throat or tongue which makes it difficult to swallow or breathe, shortness of breath, feeling of loss of consciousness, or skin rash during or after the injection, then tell your doctor immediately. Immunisations (vaccinations) Please inform your doctor if you have received a vaccine in the last 4 weeks, or if you plan to be vaccinated in the near future. Children and adolescents Do not give this medicine to children below 18 years of age because the safety and efficacy of Vyvgart have not been established in this population. Elderly There are no special precautions needed for the treatment of patients who are older than 65 years of age. Other medicines and Vyvgart Tell your doctor if you are using, have recently used or might use any other medicines. Pregnancy, breast-feeding and fertility If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. Driving and using machines Vyvgart is not expected to influence the ability to drive or use machines. Vyvgart contains sodium This medicinal product contains less than 1 mmol sodium (23 mg) per vial, that is to say essentially "sodium-free". Vyvgart contains polysorbate This medicine contains 2.7 mg of polysorbate 20 in each vial which is equivalent to 0.4 mg/mL. Polysorbates may cause allergic reactions. Tell your doctor if you have any known allergies.
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Vyvgart
Always use this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure. What dose of Vyvgart you will receive and how often Generalized myasthenia gravis The recommended dose is 1 000 mg given in cycles of one injection per week for 4 weeks. Your doctor will determine when further treatment cycles are needed. If you are already on intravenous Vyvgart treatment and wish to transition to Vyvgart subcutaneous, you should receive the subcutaneous injection instead of your intravenous infusion at the start of the next treatment cycle. Chronic inflammatory demyelinating polyneuropathy The recommended dose is 1 000 mg, one injection per week. Depending on how you respond to treatment, your doctor may change this to 1 injection every 2 weeks. Injecting Vyvgart Vyvgart is given by injection under the skin (subcutaneously). You and your doctor should decide if, after adequate training, you or your caregiver may inject Vyvgart. The first self-injection should be carried out in front of your healthcare provider. It is important not to try to inject Vyvgart before being trained by a healthcare professional. If you or your caregiver inject Vyvgart, you or your caregiver must carefully read and follow the Instructions for administration at the end of this leaflet (see "Important instructions for use"). Talk to your doctor, pharmacist or nurse if you have any questions about giving yourself an injection. If you use more Vyvgart than you should Because Vyvgart is given in one single-use vial, it is unlikely that you will receive too much. However, if you are worried, please contact your doctor, pharmacist or nurse for advice. If you miss a dose of or forget an appointment to receive Vyvgart Keep track of your next dose. It is important to use Vyvgart exactly as prescribed by your doctor. • If you miss your dose within three days of when you are supposed to take it, take your dose as soon as you remember and then follow your original dosing schedule. • If you miss your dose by more than three days, ask your doctor when to take your next dose. • If you forget an appointment, please contact your doctor immediately for advice. Do not take a double dose to make up for a forgotten dose. If you stop using Vyvgart Interrupting or stopping treatment with Vyvgart may cause your symptoms to come back. Please speak to your doctor before stopping Vyvgart. Your doctor will discuss the possible side effects and risks with you. Your doctor will also want to monitor you closely. If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse. 4.
Like all medicines, this medicine can cause side effects, although not everybody gets them. Your doctor will discuss the possible side effects with you and explain the risks and benefits of Vyvgart with you prior to treatment. 3
Tell your doctor straight away if you notice: Signs of a serious allergic reaction (anaphylactic reaction) such as swelling of the face, lips, throat or tongue which makes it difficult to swallow or breathe, shortness of breath, feeling of loss of consciousness, or skin rash during or after the injection. If you are not sure what the side effects below are, ask your doctor to explain them to you. Very common (may affect more than 1 in 10 people) • nose and throat (upper respiratory tract) infections • reactions where the injection was given, which may include redness, itching, pain. These injection site reactions are usually mild to moderate and usually occur within a day after the injection. Common (may affect up to 1 in 10 people) • pain or a burning sensation during urination, which may be a sign of a urinary tract infection • inflammation of the airways in the lungs (bronchitis) • muscle pain (myalgia) • nausea. Not known (frequency cannot be estimated from the available data) • allergic reactions during or after injection swelling of the face, lips, throat, or tongue which makes it difficult to swallow or breathe, shortness of breath pale skin, a weak and rapid pulse, or a feeling of loss of consciousness sudden rash, itching, or hives. Reporting of side effects If you get any side effects, talk to your doctor. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard or search for MRHA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine. 5.
Vyvgart
Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the carton and on the label after "EXP". The expiry date refers to the last day of that month. Store in a refrigerator (2 °C – 8 °C). Do not freeze. If needed, unopened vials may be stored at room temperature (up to 30 °C) for up to 3 days. After storage at room temperature unopened vials may be returned to the refrigerator. The total amount of time outside cold storage and at room temperature should not exceed 3 days. Store in the original package in order to protect from light. Do not use this medicine if you notice visible particles. Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.
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What Vyvgart contains The active substance is efgartigimod alfa. Each vial contains 1 000 mg efgartigimod alfa in 5.6 mL. Each mL contains 180 mg of efgartigimod alfa. The other ingredients are: Recombinant human hyaluronidase (rHuPH20), L-histidine, L-histidine hydrochloride monohydrate, L-methionine, Polysorbate 20 (E432), Sodium chloride, sucrose, Water for injections. See section 2 "Vyvgart contains sodium". What Vyvgart looks like and contents of the pack Vyvgart is a ready to use, slightly yellow, clear to slightly cloudy solution, supplied as a solution for subcutaneous injection. Marketing Authorisation Holder and Manufacturer argenx BV Industriepark-Zwijnaarde 7 9052 Gent Belgium e-mail: [email protected] For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder: Tel. +44 (0) 20 4532 4016 This leaflet was last revised in September 2025.
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———————————————————————————————————————–Important instructions for use Vyvgart 1 000 mg solution for injection efgartigimod alfa Subcutaneous use In order to improve the traceability of biological medicinal products, the name and the batch number of the administered product should be clearly recorded. Be sure to read and understand these instructions for use before injecting Vyvgart. If you or your caregiver are willing to administer Vyvgart, you will get training on how to inject Vyvgart by your healthcare professional. Your healthcare professional should show you or your caregiver how to prepare and inject Vyvgart properly before using it for the first time. A demonstration of proper self-administration under supervision of healthcare professional is considered necessary. It is important that you do not try to inject the medicinal product until you have been trained and you or your caregiver are sure that you understand how to use Vyvgart. Ask your healthcare professional if you have any questions. Important information you need to know before injecting Vyvgart subcutaneous • For subcutaneous use only. • The vial is for single use only. Do not save vials, even if they are not empty. • Do not use a vial if you see unusual cloudiness or visible particles. The medicine should appear slightly yellow, clear to slightly cloudy. • Do not shake the vial during handling. • Do not use damaged vials or vials missing a protective cap. Report and return damaged or uncapped vials to the pharmacy. Storing Vyvgart • Store in a refrigerator (2 °C – 8 °C). • Do not freeze. • If needed, unopened vials may be stored at room temperature (up to 30 °C) for up to 3 days. After storage at room temperature unopened vials may be returned to the refrigerator. The total amount of time outside cold storage and at room temperature should not exceed 3 days. • Store in the original package in order to protect from light. • Keep this medicine out of the sight and reach of children. Package contents 1 vial containing Vyvgart
Vyvgart package leaflet and instructions for use
Additional supplies not included Store additional supplies at room temperature in a dry location Alcohol swabs
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Syringe 10 mL
Transfer needle 18-gauge, ≥38 mm length
Winged infusion set 25-gauge, 30 cm tubing, maximum priming volume of 0.4 mL
Sterile gauze
Adhesive bandage
Sharps container
Preparing the supplies Step 1 Remove vial carton from the refrigerator. Step 2 Remove the vial from the carton and check:
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Step 3 Wait at least 15 minutes for the vial to naturally warm-up to room temperature. Check if the medicine in the vial is slightly yellow, clear to slightly cloudy, and has no visible particles.
5b. Wash your hands with soap and thoroughly dry them.
Preparing the syringe Step 6 Remove the plastic flip-off protective cap from the vial. The aluminium shield should remain in place.
Step 7 Clean the rubber stopper with a new alcohol swab. Allow to air dry naturally for at least 30 seconds. Do not blow on the rubber stopper.
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Step 8 Unwrap the syringe and transfer needle. Push the transfer needle onto the syringe and twist it clockwise until the needle is firmly connected to the syringe. Do not touch the tip of the syringe or the bottom of the needle to avoid germs and infection risk.
Step 9 Slowly pull back on the plunger and draw between 6.2 to 6.8 mL air into the syringe.
Step 10 10a. Hold the syringe at the needle hub where the syringe is connected to the needle. 10b. Grip the transfer needle cap and carefully pull the needle cap straight off, away from your body. 10c. Place the transfer needle cap down on a clean, flat surface.
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10b)
10c)
Step 12 Turn the vial upside down while keeping transfer needle in the vial.
Step 13 13a. Make sure the transfer needle in the vial points upwards with the needle tip above the medicine solution. 13b. Gently push the plunger to inject all the air from the syringe into the empty space above the medicine solution in the vial. 13c. Keep your finger pressed down on the syringe plunger. Do not inject air into the medicine solution as this could create air bubbles or foam.
Step 14 Fill the syringe, as follows: 14a. Keep your finger pressed on the syringe plunger and slide the transfer needle tip into the medicine solution in the neck of the vial (close to the vial cap) so that the needle tip remains completely covered in the solution. 14b. Slowly pull back the plunger, keeping the transfer needle tip in the solution to avoid air bubbles and foam in the syringe. Fill the syringe with the entire content of the vial.
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14a)
14b)
Step 15 Remove large air bubbles, if present. 15a. Keep the transfer needle in the vial and check the syringe for large air bubbles. 15b. Remove the large air bubbles by gently tapping the syringe barrel with your fingers until the air bubbles rise to the top of the syringe. 15c. Move the transfer needle tip above the medicine solution and slowly push the plunger up to push the air bubbles out of the syringe. 15d. To remove any remaining medicine solution from the vial, move the tip of the transfer needle into the solution again and slowly pull back the plunger until you have the full contents of the vial in the syringe. 15e. Repeat the steps above until you have removed the large air bubbles. If you cannot remove all of the liquid from the vial, turn the vial upright to reach the remaining amount.
Step 16 16a. Turn the vial upright and remove the syringe and transfer needle from the vial. 16b. Using one hand, slide the transfer needle into the cap and scoop upwards to cover the needle. 16c. After the transfer needle is covered, twist the transfer needle cap onto the syringe to fully attach it.
15c)
15e)
16a)
16b)
16c)
Step 17 17a. Gently pull and twist the transfer needle counterclockwise to remove it from the syringe. 17b. Throw away (dispose of) the transfer needle in the sharps container.
17a)
17b)
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Preparing to inject Vyvgart Step 18 18a. Remove the cap from the end of the winged infusion set. 18b. Gently push and twist the end of the winged infusion set clockwise onto the syringe until firmly connected. The final syringe setup should look like the figure to the right.
Step 19 19a. Fill the tubing of the winged infusion set by gently pressing the syringe plunger until the plunger is at the 5.6 mL mark. You should see some liquid at the end of the needle. 19b. Place the syringe and attached winged infusion set down on the clean, flat surface. Do not wipe off any excess medicine solution expelled from the infusion set while filling the tubing.
Step 20 Choose an injection site
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Step 21 Disinfect the injection site with a new alcohol swab. Use a circular motion and wipe from inside to outside. Allow the site to air dry for at least 30 seconds. Do not touch the injection site after disinfecting.
Injecting Vyvgart Step 22 22a. Remove the needle cap carefully from the winged infusion set. 22b. Fold the wings of the infusion set upwards and hold the wings between your thumb and index finger, with the needle below the wings. Note: To avoid infection, make sure the needle does not come into contact with anything prior to skin insertion.
Step 23 With your free hand, pinch a fold of skin around the disinfected injection site and lift upwards. Grab enough skin to create a "tent" for the needle to insert into. Do not hold the skin too tight to avoid bruising. Step 24 Insert the needle into the middle of the pinched skin area at an angle of about 45 degrees. Note: The needle should smoothly insert into the skin. If you feel resistance, you can pull the needle back slightly. Step 25 Check the infusion set. Make sure there is no blood. Important: If you see blood, slightly pull back on the needle without removing the needle from the skin.
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22a)
22b)
Step 26 Inject by pushing the plunger of the syringe with steady pressure until no medicine remains in the syringe. This corresponds to the injection of the recommended dose of 5.6 mL. The injection usually takes 30 to 90 seconds. Note:
Disposing of Vyvgart Step 28 Throw away (dispose of) the winged infusion set (with the attached needle and syringe) and the vial into the sharps container. If you do not have an sharps disposal container, a household container can be used if it is:
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VYVGART 1000 mg solution for injection comes as injection containing 1000mg. Always follow the dose your doctor or pharmacist has given you, and read the leaflet that comes with the medicine.
The active substance in VYVGART 1000 mg solution for injection is efgartigimod alfa.
Medicines with the same active substance, strength and form include: Vyvgart 1000 mg Solution for injection in pre-filled syringe. They are interchangeable only if your prescriber or pharmacist says so.
This leaflet reproduces the patient information leaflet approved for VYVGART 1000 mg solution for injection, as published on the electronic medicines compendium (emc). The version printed inside your medicine’s packaging is the one that applies to you.
Whether a medicine is available over the counter or on prescription only depends on its licence. Check the leaflet, or ask your pharmacist — they can tell you straight away.
The text above reproduces the patient information leaflet approved for this medicine, restructured for easier reading.
Vyvgart is indicated as
- an add-on to standard therapy for the treatment of adult patients with generalised Myasthenia Gravis (gMG) who are anti-acetylcholine receptor (AChR) antibody positive.
- monotherapy for the treatment of adult patients with progressive or relapsing active chronic inflammatory demyelinating polyneuropathy (CIDP) after prior treatment with corticosteroids or immunoglobulins.
Treatment must be initiated and supervised by a physician experienced in the management of patients with neuromuscular disorders.
Posology
Generalised myasthenia gravis
The first treatment cycle and first administration of the second treatment cycle must be administered either by or under the supervision of a healthcare professional. Subsequent treatment should be administered by a healthcare professional or may be administered at home by a patient or caregiver after adequate training in the subcutaneous injection technique.
The recommended dose is 1 000 mg to be administered subcutaneously in cycles of once weekly injections for 4 weeks. Subsequent treatment cycles should be administered according to clinical evaluation. The frequency of treatment cycles may vary by patient (see section 5.1).
In the clinical development program, the earliest time to initiate a subsequent treatment cycle was 7 weeks from the initial infusion of the previous cycle.
For patients currently receiving efgartigimod alfa intravenously, the solution for subcutaneous injection may be used as an alternative. It is recommended to switch between formulations at the start of a new treatment cycle. No safety and efficacy data in patients switching formulations during the same cycle is available.
Chronic inflammatory demyelinating polyneuropathy
The first 4 injections must be administered either by or under the supervision of a healthcare professional. Subsequent injections should be administered by a healthcare professional or may be administered at home by a patient or caregiver after adequate training in the subcutaneous injection technique.
The recommended dose is 1 000 mg administered subcutaneously as once-weekly injections.
Treatment is initiated with a weekly dose regimen and may be adjusted to every other week based on clinical evaluation. In case of worsening of symptoms, administration of once-weekly injections should be resumed.
For those patients transitioning from their current CIDP therapies, Vyvgart treatment should preferably be initiated before the clinical effect of these prior therapies starts to decrease.
Clinical response is usually achieved within 3 months of initiation of treatment with efgartigimod alfa subcutaneous. Clinical evaluation should be considered 3 to 6 months after treatment initiation to assess the treatment effect and at regular intervals thereafter.
Missed dose
An interval of at least 3 days should be observed between two consecutive administrations. When administrations cannot be done at the scheduled time point, they should be performed as soon as possible and at least 3 days ahead of the following administration. If there are less than 3 days to the next administration, the missed dose should be skipped and the next dose should be administered at the scheduled time point.
Special populations
Elderly
No dose adjustment is required in patients aged 65 years and older (see section 5.2).
Renal impairment
Limited safety and efficacy data in patients with mild renal impairment is available, no dose adjustment is required for patients with mild renal impairment. There is very limited safety and efficacy data in patients with moderate or severe renal impairment (see section 5.2).
Hepatic impairment
No data in patients with hepatic impairment are available. No dose adjustment is required in patients with hepatic impairment (see section 5.2).
Paediatric population
The safety and efficacy of efgartigimod alfa in paediatric population have not yet been established. No data are available.
Method of administration
This medicinal product should only be administered via subcutaneous injection. Do not administer intravenously.
After removing the vial from the refrigerator, wait for at least 15 minutes before injecting to allow the solution to reach room temperature. Use aseptic technique when preparing and administering the medicinal product solution. Do not shake the vial.
The solution for injection can be administered using a polypropylene syringe, stainless steel transfer needles and polyvinyl chloride winged infusion set, with a maximum priming volume of 0.4 mL.
• Withdraw the entire content of the efgartigimod alfa solution from the vial using a transfer needle.
• Change the needle on the syringe to the winged infusion set.
• Prior to administration, the volume in the syringe should be adjusted to 5.6 mL.
During the initial administrations of efgartigimod alfa (see section 4.2), appropriate treatment for injection and hypersensitivity-related reactions should be readily available (see section 4.4). The recommended injection sites (abdomen) should be rotated and injections should never be given into moles, scars, or areas where the skin is tender, bruised, red or hard. The volume of 5.6 mL should be injected over 30 to 90 seconds. The injection may be slowed if the patient experiences discomfort.
The first self-administration must always be conducted under the supervision of a healthcare professional. After adequate training in subcutaneous injection technique, patients or caregivers may inject the medicinal product at home if a healthcare professional determines that it is appropriate. Patients or caregivers should be instructed to inject Vyvgart according to the directions provided in the package leaflet.
For comprehensive instructions for the administration of the medicinal product, please refer to the Instructions for Use in the package leaflet.
Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
Traceability
In order to improve the traceability of biological medicinal products, the name and the batch number of the administered product should be clearly recorded.
Myasthenia Gravis Foundation of America (MGFA) Class V patients
Treatment with efgartigimod alfa in patients with MGFA Class V (i.e. myasthenic crisis), defined as intubation with or without mechanical ventilation except in the setting of routine postoperative care, has not been studied. The sequence of therapy initiation between established therapies for MG crisis and efgartigimod alfa, and their potential interactions, should be considered (see section 4.5).
Infections
As efgartigimod alfa causes transient reduction in IgG levels the risk of infections may increase (see sections 4.8 and 5.1). The most common infections observed in clinical trials were upper respiratory tract infections and urinary tract infections (see section 4.8). Patients should be monitored for clinical signs and symptoms of infections during treatment with Vyvgart. In patients with an active infection, the benefit-risk of maintaining or withholding treatment with efgartigimod alfa should be considered until the infection has resolved. If serious infections occur, delaying treatment with efgartigimod alfa should be considered until the infection has resolved.
Injection reactions and hypersensitivity reactions
Injection reactions such as rash or pruritus were reported in the clinical trials (see section 4.8). These were mild to moderate. Cases of anaphylactic reaction have been reported with efgartigimod alfa intravenous in the post-marketing setting. The first administrations of Vyvgart must be performed under the supervision of a healthcare professional (see section 4.2). Patients should be monitored for 30 minutes after administration for clinical signs and symptoms of injection reactions. Should a reaction occur and based on the severity of the reaction, appropriate supportive measures should be initiated. Subsequent injections may be cautiously administered, based on clinical evaluation.
If an anaphylactic reaction is suspected, administration of Vyvgart should be immediately discontinued and appropriate medical treatment initiated. Patients should be informed of the signs and symptoms of hypersensitivity and anaphylactic reactions and advised to contact their healthcare professional immediately should they occur.
Immunisations
All vaccines should be administered according to immunisation guidelines.
The safety of immunisation with live or live-attenuated vaccines and the response to immunisation with these vaccines during treatment with efgartigimod alfa are unknown. For patients that are being treated with efgartigimod alfa, vaccination with live or live-attenuated vaccines is generally not recommended. If vaccination with live or live-attenuated vaccines is required, these vaccines should be administered at least 4 weeks before treatment and at least 2 weeks after the last dose of efgartigimod alfa.
Other vaccines may be administered as needed at any time during treatment with efgartigimod alfa.
Immunogenicity
In the active-controlled study ARGX-113-2001, pre‑existing antibodies that bind to efgartigimod alfa were detected in 12/110 (11%) patients with gMG. Anti‑efgartigimod alfa antibodies were detected in 19/55 (35%) patients treated with efgartigimod alfa subcutaneous compared to 11/55 (20%) patients treated with the intravenous formulation. Neutralising antibodies were detected in 2 (4%) patients treated with efgartigimod alfa subcutaneous and 2 (4%) patients treated with efgartigimod alfa intravenous.
In study ARGX‑113‑1802, pre-existing antibodies that bind to efgartigimod alfa were detected in 13/317 (4.1%) patients with CIDP. Anti-efgartigimod alfa antibodies were detected in 20/317 (6.3%) of patients treated in the open-label part of the study (Stage A), and in 2/111 (1.8%) of patients treated in the placebo-controlled part (Stage B). Neutralising antibodies were detected in 1 (0.3%) patient in the open-label part of the study only (see section 5.1).
The impact of antibodies to efgartigimod alfa on clinical efficacy or safety, pharmacokinetics and pharmacodynamic cannot be assessed given the low incidence of neutralizing antibodies.
Immunosuppressant and anticholinesterase therapies
When non-steroidal immunosuppressants, corticosteroids and anticholinesterase therapies are decreased or discontinued, patients should be monitored closely for signs of disease exacerbation.
Excipients with known effect
Sodium
This medicinal product contains less than 1 mmol sodium (23 mg) per vial, that is to say essentially 'sodium-free'.
Polysorbates
This medicinal product contains 2.7 mg of polysorbate 20 in each vial which is equivalent to 0.4 mg/mL. Polysorbates may cause allergic reactions.
No interaction studies have been performed.
Efgartigimod alfa may decrease concentrations of compounds that bind to the human neonatal Fc Receptor (FcRn), i.e., immunoglobulin products, monoclonal antibodies, or antibody derivatives containing the human Fc domain of the IgG subclass. If possible, it is recommended to postpone the initiation of treatment with these products to 2 weeks after the last dose of Vyvgart. As a precaution, patients receiving Vyvgart while on treatment with these products should be closely monitored for the intended efficacy response of those products.
Plasma exchange, immunoadsorption, and plasmapheresis may reduce circulating levels of efgartigimod alfa.
All vaccines should be administered according to immunisation guidelines.
The potential interaction with vaccines was studied in a nonclinical model using Keyhole limpet hemocyanin (KLH) as the antigen. The weekly administration of 100 mg/kg to monkeys did not impact the immune response to KLH immunisation. For patients that are being treated with efgartigimod alfa, vaccination with live or live‑attenuated vaccines is generally not recommended. If vaccination with live or live‑attenuated vaccines is required, these vaccines should be administered at least 4 weeks before treatment and at least 2 weeks after the last dose of efgartigimod alfa (see section 4.4).
Pregnancy
There is no available data on the use of efgartigimod alfa during pregnancy. Antibodies including therapeutic monoclonal antibodies are known to be actively transported across the placenta (after 30 weeks of gestation) by binding to FcRn.
Efgartigimod alfa may be transmitted from the mother to the developing foetus. As efgartigimod alfa is expected to reduce maternal antibody levels, and is also expected to inhibit the transfer of maternal antibodies to the foetus, reduction in passive protection to the newborn is anticipated. Therefore, risks and benefits of administering live/live-attenuated vaccines to infants exposed to efgartigimod alfa in utero should be considered (see section 4.4).
Treatment of pregnant women with Vyvgart should only be considered if the clinical benefit outweighs the risks.
Breast-feeding
There is no information regarding the presence of efgartigimod alfa in human milk, the effects on the breastfed child or the effects on milk production. Animal studies on the transfer of efgartigimod alfa into milk have not been conducted, and therefore, excretion into maternal milk cannot be excluded. Maternal IgG is known to be present in human milk. Treatment of lactating women with efgartigimod alfa should only be considered if the clinical benefit outweighs the risks.
Fertility
There is no available data on the effect of efgartigimod alfa on fertility in humans. Animal studies showed no impact of efgartigimod alfa on male and female fertility parameters (see section 5.3).
Vyvgart has no or negligible influence on the ability to drive and use machines.
Summary of the safety profile
The most frequently observed adverse reactions were injection site reactions (33%), upper respiratory tract infections (10.7%) and urinary tract infections (9.5%).
The overall safety profile of Vyvgart subcutaneous for both cyclic and continuous dose regimens was consistent with the known safety profile of the intravenous formulation.
Tabulated list of adverse reactions
Adverse reactions described in this section were identified in clinical trials and from post-marketing reports. These reactions are presented by system organ class and preferred term. Frequency categories are defined as: very common (≥ 1/10), common (≥ 1/100 to < 1/10), uncommon (≥ 1/1 000 to < 1/100), rare (≥ 1/10 000 to < 1/1 000) or not known (cannot be estimated from the available data). Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness.
Table 1. Adverse reactions
System organ class
Adverse reaction
Frequency category
Infections and infestations*
Upper respiratory tract infections
Very common
Urinary tract infections
Common
Bronchitis
Common
Immune system disorders
Anaphylactic reaction a
Not known
Gastrointestinal disorders
Nausea b
Common
Musculoskeletal and connective tissue disorders
Myalgia
Common
General disorders and administration site conditions*
Injection site reactions c, d
Very common
Injury, poisoning and procedural complications*
Procedural headache e
Common
* See paragraph “Description of selected adverse reactions”
a From spontaneous post-marketing reporting with intravenous route of administration
b From spontaneous post-marketing reporting.
c Subcutaneous administration only.
d (e.g. injection site rash, injection site erythema, injection site pruritus, injection site pain)
e Intravenous administration only.
Description of selected adverse reactions
Injection site reactions
In the pooled dataset from two clinical studies in gMG with efgartigimod alfa subcutaneous (n = 168), all injection site reactions were mild to moderate in severity and did not lead to treatment discontinuation. 44.0% (n = 74)) of patients experienced an injection site reaction. Injection site reactions occurred within 24 hours after administration in 78.4% (58/74) of patients and resolved without treatment in 85.1% (63/74) of the patients. The incidence of injection site reactions was the highest in the first treatment cycle, reported in 36.3% (61/168) of patients during the first treatment cycle and decreased to 20.1% (30/149), 15.4% (18/117) and 12.5% (10/80) of patients with the second, third and fourth treatment cycle. In a pooled dataset from 2 clinical studies in patients with CIDP who received continuous administration of efgartigimod alfa subcutaneous the incidence of injection site reactions was 26% (61/235). Analysis by 3-month intervals showed that the percentage of participants with injection-site reactions was highest in the first 3 months of treatment (73 [22.2%] participants) and decreased in subsequent 3-month intervals (range: 0 to 17 [6.8%] participants).
Infections
In the gMG ARGX-113-1704 placebo-controlled study with efgartigimod alfa intravenous, the most frequently reported adverse reactions were infections, and the most reported infections were upper respiratory tract infections, (10.7% [n = 9] of patients treated with efgartigimod alfa intravenous and 4.8% [n = 4] of patients treated with placebo) and urinary tract infections (9.5% [n = 8] of patients treated with efgartigimod alfa intravenous and 4.8% [n = 4] of patients treated with placebo). These infections were mild to moderate in severity in patients who received efgartigimod alfa intravenous (≤ Grade 2 according to the Common Terminology Criteria for Adverse Events). Overall, treatment emergent infections were reported in 46.4% (n = 39) of patients treated with efgartigimod alfa intravenous and 37.3% (n = 31) of patients treated with placebo. The median time from treatment initiation to emergence of infections was 6 weeks. Incidence of infections did not increase with subsequent treatment cycles. Treatment discontinuation or temporary interruption of treatment due to an infection occurred in less than 2% of patients. In the placebo-controlled part of the ARGX‑113‑1802 study in patients with CIDP, continuous administration of efgartigimod alfa subcutaneous was not associated with any increase in the incidence of infections (31.5% [35/111] in the efgartigimod alfa subcutaneous group and 33.6% [37/110] in the placebo group) (see section 5.1).
Procedural headache
Procedural headache was reported in 4.8% of the patients treated with efgartigimod alfa intravenous and 1.2% of patients treated with placebo. Procedural headache was reported when a headache was judged to be temporally related to the intravenous infusion of efgartigimod alfa. All were mild or moderate except one event which was reported as severe (Grade 3).
All other adverse reactions were mild or moderate with the exception of one case of myalgia (Grade 3).
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard or search for MRHA Yellow Card in the Google Play or Apple App Store.
There are no known specific signs and symptoms of overdose with efgartigimod alfa. In the event of an overdose the adverse events that may occur are not expected to be different from those that may be observed at the recommended dose. Patients should be monitored for adverse reactions, and appropriate symptomatic and supportive treatment initiated. There is no specific antidote for overdose with efgartigimod alfa.
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