Different Monoclonal Antibodies in Myasthenia Gravis: A Bayesian Network Meta-Analysis

Abstract

Background: Myasthenia gravis (MG) is a common autoimmune disease with acquired neuromuscular transmission disorders. Recently, monoclonal antibodies have been shown to successfully treat a variety of diseases.Methods: In this meta-analysis, an appropriate search strategy was used to search eligible randomized controlled trials (RCTs) on different monoclonal antibodies to treat patients with MG published up to September 2021 from the embase, PubMed, and Cochrane Library. We assessed the average difference or odds ratio between each drug and placebo and summarized them as the average and 95% confidence interval (CI), respectively.Results: In indicators of efficacy, patients receiving eculizumab (MD, −1.9; 95% CI, −3.2–0.76) had decreases in MG-ADL scores compared to placebo. In addition, only eculizumab (MD, −3.1; 95% CI, −4.7–1.5) and efgartigimod (MD, −1.4; 95% CI, −2.1–0.68) showed a significant difference from placebo in the amount of reduction in QMG scores, while neither of the other two monoclonal antibodies was statistically significant. With regard to the safety of monoclonal antibody therapy, there was no significant difference in the probability of AE in subjects treated with any of the four monoclonal antibodies compared to placebo.Conclusions: eculizumab was effective in reducing MG-ADL scores and QMG scores in myasthenia gravis. Meanwhile, eculizumab also caused fewer AE. As an emerging therapy, monoclonal antibodies are prospective in the treatment of MG. However, more researches are required to be invested in the future as the results obtained from small sample sizes are not reliable enough.

Efgartigimod Alfa in Generalised Myasthenia Gravis: A Profile of Its Use

“…However, given their indirect nature, these findings (i.e. efgartigimod alfa has the highest efficacy in reducing MG-ADL score [25]; no significant differences in reducing MG-ADL scores between efgartigimod alfa and other monoclonal antibodies [26]) should be interpreted with caution. Direct head-to-head trials comparing the efficacy of efgartigimod alfa with conventional and newer agents would be of interest.…”

“…In a risk-benefit analysis in patients with AChR antibody positive myasthenia gravis, efgartigimod alfa is associated with favourable clinical benefits and similar tolerability compared with other treatments for myasthenia gravis, such as eculizumab, ravulizumab and intravenous immunoglobulin [24]. In addition, results from a model-based and network meta-analysis comparing efgartigimod alfa with various NSISTs and monoclonal antibodies have been reported [25,26]. However, given their indirect nature, these findings (i.e.…”

Eculizumab in myasthenia gravis: A review

“…in 2021, eculizumab was superior to efgartigimod, zilucoplan, belimumab, and iscalimab in QMG scores. [ 40 41 ] Eculizumab was also noted to have a more rapid onset and be more effective than immunosuppressants such as mycophenolate mofetil, prednisone, tacrolimus, and cyclosporine. When evaluating based on MG-ADL scores, eculizumab was superior to belimumab, iscalimab, and zilucoplan but inferior to efgartigimod.…”

“…[ 40 ] A similar Bayesian network meta-analysis found that eculizumab had superior improvement in MG-ADL and QMG scores compared to belimumab, efgartigimod, rozanolixizumab, and placebo. [ 41 ] Eculizumab was associated with a higher probability of adverse events than placebo, efgartigimod, and belimumab. However, rates of serious adverse events occurred at higher rates in placebo than in eculizumab.…”

“…However, rates of serious adverse events occurred at higher rates in placebo than in eculizumab. [ 41 ]…”