PMID- 30809966
OWN - NLM
STAT- MEDLINE
DCOM- 20200817
LR  - 20210109
IS  - 1755-5949 (Electronic)
IS  - 1755-5930 (Print)
IS  - 1755-5930 (Linking)
VI  - 25
IP  - 5
DP  - 2019 May
TI  - Immunosuppressive and monoclonal antibody treatment for myasthenia gravis: A 
      network meta-analysis.
PG  - 647-658
LID - 10.1111/cns.13110 [doi]
AB  - BACKGROUND: We intended to compare and rank all the immunotherapies including 
      immunosuppressant agents or monoclonal antibodies for myasthenia gravis (MG). 
      METHODS: 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). RESULTS: 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. CONCLUSION: 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 may be limited by their multiple or severe 
      AEs.
CI  - (c) 2019 The Authors. CNS Neuroscience & Therapeutics Published by John Wiley & 
      Sons Ltd.
FAU - Wang, Liang
AU  - Wang L
AD  - Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
FAU - Huan, Xiao
AU  - Huan X
AD  - Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
FAU - Xi, Jian-Ying
AU  - Xi JY
AD  - Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
FAU - Wu, Hui
AU  - Wu H
AD  - Department of Neurology, Jing'an District Centre Hospital of Shanghai, Fudan 
      University, Shanghai, China.
FAU - Zhou, Lei
AU  - Zhou L
AD  - Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
FAU - Lu, Jia-Hong
AU  - Lu JH
AD  - Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
FAU - Zhang, Tian-Song
AU  - Zhang TS
AD  - Department of Chinese Traditional Medicine, Jing'an District Centre Hospital of 
      Shanghai, Fudan University, Shanghai, China.
FAU - Zhao, Chong-Bo
AU  - Zhao CB
AUID- ORCID: 0000-0001-9481-1418
AD  - Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
AD  - Department of Neurology, Jing'an District Centre Hospital of Shanghai, Fudan 
      University, Shanghai, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
DEP - 20190226
PL  - England
TA  - CNS Neurosci Ther
JT  - CNS neuroscience & therapeutics
JID - 101473265
RN  - 0 (Antibodies, Monoclonal)
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Antibodies, Monoclonal/*therapeutic use
MH  - Humans
MH  - Immunosuppressive Agents/*therapeutic use
MH  - Myasthenia Gravis/*therapy
MH  - Network Meta-Analysis
PMC - PMC6488910
OTO - NOTNLM
OT  - immunosuppressive agents
OT  - immunotherapy
OT  - monoclonal antibody
OT  - myasthenia gravis
COIS- The authors declare that they have no conflict of interest.
EDAT- 2019/02/28 06:00
MHDA- 2020/08/18 06:00
PMCR- 2019/02/26
CRDT- 2019/02/28 06:00
PHST- 2018/12/04 00:00 [received]
PHST- 2019/01/22 00:00 [revised]
PHST- 2019/01/23 00:00 [accepted]
PHST- 2019/02/28 06:00 [pubmed]
PHST- 2020/08/18 06:00 [medline]
PHST- 2019/02/28 06:00 [entrez]
PHST- 2019/02/26 00:00 [pmc-release]
AID - CNS13110 [pii]
AID - 10.1111/cns.13110 [doi]
PST - ppublish
SO  - CNS Neurosci Ther. 2019 May;25(5):647-658. doi: 10.1111/cns.13110. Epub 2019 Feb 
      26.