Comparing Efficacy and Safety of Various Monoclonal Antibodies in Myasthenia Gravis: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

Abstract / Summary

Myasthenia gravis (MG) is an autoimmune disorder that causes muscle weakness due to disrupted neuromuscular transmission. This network meta-analysis compared the safety and effectiveness of monoclonal antibodies used to treat MG. PubMed, Cochrane Central, and ScienceDirect were searched through June 2025. A frequentist network meta-analysis was conducted using the "meta" and "netmeta" packages in RStudio version 4.3.3. Treatment rankings were determined by p-scores. Eighteen randomized controlled trials (RCTs) were included in this network meta-analysis. Rozanolixzumab (ROZ) 10 mg/kg significantly decreased the MG Activities of Daily Living (MG-ADL) score compared to placebo (MD = -2.33; 95%CI:[-3.60, -1.06]; p = 0.0003) and was ranked best (p-score = 0.77) regarding this outcome. Batoclimab (BAT) 680 mg significantly reduced the Quantitative MG (QMG) score compared to placebo (MD = -5.17; 95%CI:[-6.44, -3.89]; p <0.0001) and was rated the top performer (p-score = 0.96) for this endpoint. Regarding the MG Composite (MGC) score, BAT 340 mg was ranked best (p-score = 0.82), although the decrease in MGC score was insignificant (MD -5.30; 95%CI:[-11.01, 0.41]; p = 0.07). Eculizumab (ECU) was ranked best (p-score = 0.93) regarding the 15-item revised MG Quality of Life (MG-QoL 15r) score. Belimumab (BEL) 10 mg/kg was ranked best regarding the adverse events (p-score = 0.87). ROZ 10 mg/kg ranked best for MG-ADL. BAT 680 mg significantly reduced QMG and ranked best. BAT 340 mg had the highest probability of reducing the MGC score. ECU significantly decreased MG-QoL 15r and ranked best. BEL 10 mg/kg had the highest likelihood of reducing adverse events.

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