Efgartigimod reached GCC neurology centres in 2023, yet pyridostigmine and steroids still anchor treatment for more than 85% of patients.

Pyridostigmine plus corticosteroids or azathioprine remains the dominant regimen for an estimated 85% or more of GCC myasthenia gravis patients, a generic backbone that is MOH formulary listed and universally available. Diagnosis is the first bottleneck: AChR antibody testing is available at roughly 20 centres across the six GCC states, concentrated in Riyadh, Dubai, Abu Dhabi, and Doha, and presentation is frequently delayed because clinicians attribute ptosis or diplopia to the region's high rates of thyroid disease rather than to myasthenia gravis. Anti-MuSK antibody testing is available at even fewer sites, leaving many seronegative and MuSK-positive patients under-characterised.

Efgartigimod (Vyvgart), argenx's FcRn antagonist, registered with SFDA and UAE MOH in 2023 and is now available at KFSH&RC, AUH, and Hamad Medical Corporation through argenx's GCC distribution partnership with Takeda, the first novel MG mechanism to reach the region. Uptake stands at an estimated 200 to 300 patients as of mid-2024, almost entirely refractory generalised MG failing pyridostigmine, steroids, and azathioprine. Eculizumab is technically registered for refractory AChR-positive gMG via its existing PNH approval but sees very low utilisation, since NPHC has not established MG-specific coverage criteria.

Formulary inclusion, not clinical proof, decides when the FcRn class reaches standard care.

Five questions this report answers:

Q1 - Which NPHC and MOH UAE formulary criteria govern efgartigimod access today?

Q2 - Which GCC neurology centres prescribe efgartigimod, and what does the AChR testing gap mean for switch-eligible patients?

Q3 - Why does eculizumab see minimal MG utilisation in GCC despite registration?

Q4 - Why hasn't efgartigimod displaced the pyridostigmine-steroid backbone despite its 2023 SFDA registration?

Q5 - How many GCC patients remain on generic pyridostigmine while FcRn formulary criteria are still being written?

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Mike || Global Pharma Commercial Marketing Head

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