Comparison of the Efficacy and Safety of Myasthenia Gravis Treatments: A Bayesian Network Meta-Analysis
Abstract
Background and objectives: In the past decade, several novel therapies have shown promise in treating generalized myasthenia gravis (MG); however, no head-to-head prospective studies have compared their efficacy and safety. To assist clinicians in navigating this complex treatment landscape, we sought to compare treatments while accounting for differences in trial populations.
Methods: We conducted a Bayesian network meta-analysis (PROSPERO ID: CRD42023428733) of MG treatments. We searched Scopus, Embase, Web of Science, CENTRAL, and MEDLINE up to May 2, 2025, for randomized trials in MG. Two independent reviewers (N.M. and M.R.) identified prospective multiarm studies of adults (18 or older) with generalized MG that reported mean treatment difference, with uncertainty, in MG-Activities of Daily Living (MG-ADL) or Quantitative MG (QMG) score change from baseline.
Results: Of 4,823 eligible studies, 27 placebo-controlled randomized trials (placebo n = 1,086; treatment n = 1,232) were included that targeted B cells, neonatal Fc receptor (FcRn), complement activity, CD40, and interleukin-6 signaling, as well as immunoglobulin G and broad immunosuppression therapy. Compared to those treated with placebo and standard of care, QMG scores decreased by an average of -3.63 (95% credible interval -4.43 to -2.77) points more in patients treated with FcRn inhibitors, -2.59 (-3.92 to -1.28) points more in patients treated with C5 complement inhibitors (C5i), and -2.50 (-5.11 to 0.12)…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,232 participants or records.
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