OBJECTIVES: Immunoglobulins are established therapies for CIDP. Efgartigimod recently showed efficacy in the ADHERE trial. As direct efficacy comparisons are lacking, indirect comparisons are necessary.

METHODS: A systematic literature review was carried out to compare the clinical effects of efgartigimod with those of immunoglobulins, considering only experimental trials. An indirect treatment comparison (ITC) was performed to narrow the results of the literature review to EMA-authorized immunoglobulins for CIDP and relevant endpoints. Among the studies that met the predefined criteria, an ITC was considered feasible against Privigen, Hizentra, and HyQvia. The matching-adjusted indirect comparison method was chosen to control for heterogeneity in key patient characteristics.

RESULTS: When compared with low-dose Hizentra and high-dose Hizentra, efgartigimod was associated with better treatment effect in I-RODS (difference in means [95%CI] 11.35 [3.00, 19.71]; p = 0.008; 9.35 [0.78, 17.93]; p = 0.033, respectively) and mean grip strength in the dominant hand (vs high-dose Hizentra: 11.61 [0.14, 23.08]; p = 0.047). When compared with Hyqvia, efgartigimod showed a better treatment effect in aINCAT (-0.88 [-1.72, -0.04]; p = 0.040) and I-RODS (12.16 [2.67, 21.65]; p = 0.012). Time to aINCAT deterioration was comparable between efgartigimod and immunoglobulins, regardless of the type of immunoglobulin considered. For all the other endpoints, the results were comparable between the treatments.

CONCLUSIONS: Despite the limitations of the analysis and the limited comparability of the studies, the ITC results indicate that efgartigimod has a comparable or better efficacy profile than EMA-approved immunoglobulins. Further prospective comparative studies are needed to confirm these results.