Immunosuppressive and monoclonal antibody treatment for myasthenia gravis: A network meta-analysis

CNS Neuroscience & Therapeutics
Liang WangChongbo Zhao

Abstract

We intended to compare and rank all the immunotherapies including immunosuppressant agents or monoclonal antibodies for myasthenia gravis (MG). A network meta-analysis was performed to synthesize the direct evidence and indirect evidence. Quantitative MG score (QMGS) was defined as the primary outcome. The secondary outcomes included the glucocorticoid reduction and hazard ratios (HR) from the counts of adverse events (AEs). We identified 14 studies including 808 MG patients. For the primary outcome, cyclosporine A (CsA) was hierarchically the best with statistical significances of -1.18 (-1.81, -0.59) vs placebo (PLA), -0.98 (-1.72, -0.23) vs mycophenolate mofetil, and -0.77 (-1.57, -0.032) vs tacrolimus (TAC). When the intervention periods were controlled, both eculizumab (ECZ) of -1.50 (-2.81, -0.18) and CsA of -1.23 (-1.81, -0.64) vs PLA reached a statistical significance. Belimumab and ECZ ranked the most tolerable therapies while CsA of 2.41 (0.58, 10.01) ranked the last vs PLA. These findings demonstrated that ECZ represented the most effective and tolerable therapeutic alternative to be recommended for refractory MG. TAC may be a beneficial therapy to treat MG extensively while the efficacy of CsA and cyclophosphamide m...Continue Reading

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Citations

Aug 9, 2019·Annals of the New York Academy of Sciences·Xiao-Jun CaiZheng Jiao
Jun 4, 2019·Frontiers in Neurology·Kun HuangHuan Yang
Oct 27, 2020·CNS Neuroscience & Therapeutics·Chao ZhangFu-Dong Shi
Jul 2, 2021·Journal of Translational Medicine·Rui ZhaoChongbo Zhao
Nov 26, 2021·Expert Opinion on Investigational Drugs·Rui ChenLujin Li

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Software Mentioned

QMGS
WinBUGS
Stata
Revman

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