PMID- 38022544
OWN - NLM
STAT- MEDLINE
DCOM- 20231201
LR  - 20240326
IS  - 1664-3224 (Electronic)
IS  - 1664-3224 (Linking)
VI  - 14
DP  - 2023
TI  - Efficacy and safety of the innovative monoclonal antibodies in adults with 
      generalized myasthenia gravis: a Bayesian network analysis.
PG  - 1280226
LID - 10.3389/fimmu.2023.1280226 [doi]
LID - 1280226
AB  - BACKGROUND: A series of clinical trials support the effectiveness of monoclonal 
      antibodies for generalized myasthenia gravis (MG) compared to the placebo, but 
      the priority among drugs remains unclear. Therefore, we conduct a frequentist 
      network meta-analysis (NMA) to compare the relative effects of different drugs 
      for generalized MG. METHODS: PubMed, Embase, Cochrane Library, and 
      clinicaltrials.gov were systematically searched for eligible studies up to 1 June 
      2023. The primary outcome was efficacy (Myasthenia Gravis Activities of Daily 
      Living [MG-ADL] score and Quantitative Myasthenia Gravis [QMG] score) and safety 
      (adverse events [AEs]). Mean difference (MD) and risk ratio (RR) with their 95% 
      credible intervals (95%CrIs) were used to show the effect size of continuous and 
      categorical variables, respectively. The quality of evidence was assessed using 
      the Grading of Recommendations Assessment, Development and Evaluation (GRADE) 
      approach. RESULTS: Thirteen studies involving 1167 individuals were identified 
      for NMA. For efficacy outcomes, belimumab, efgartigimod, mezagitamab 600mg, and 
      nipocalimab 60mg/kg were inferior to rozanolixzumab 7mg/kg (MD ranged from 2 to 
      3.69) and rozanolixzumab 10mg/kg (MD ranged from 2.04 to 3.72) in MG-ADL score, 
      and rozanolixzumab had the highest rank probability (83%) according to the 
      subjective surface under the curve ranking area (SUCRA). For QMG score, 
      batoclimab 340mg (MD ranged from 4.32 to 8.52) and batoclimab 680mg (MD ranged 
      from 4.11 to 9.31) were more effective than placebo and other monoclonal 
      antibodies except for rozanolixzumab, with the highest SUCRA value (93% and 97% 
      respectively). For safety outcomes, belimumab achieved the highest SUCRA value 
      (89.8%) with significant statistical difference compared to rozanolixzumab 7mg/kg 
      (RR 0.08, 95%CrI 0.01 to 0.94) and rozanolixzumab 10mg/kg (RR 0.08, 95%CrI 0.01 
      to 0.86). CONCLUSION: While all monoclonal antibodies were superior to the 
      placebo, rozanolixzumab and batoclimab might be the most effective for 
      generalized MG. However, rozanolixzumab was associated with higher incidence of 
      AEs. Given the limitations inherent in indirect comparisons, further head-to-head 
      and extensive observational studies are necessary to confirm our findings. 
      SYSTEMATIC REVIEW REGISTRATION: https://inplasy.com/?s=202370112, identifier 
      202370112.
CI  - Copyright (c) 2023 Chen, Qiu, Yin, Wang, Tang, Ni, Lu, Chen, Kong and Wang.
FAU - Chen, Huiru
AU  - Chen H
AD  - Department of Neurosurgery & Brain and Nerve Research Laboratory, The First 
      Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
AD  - Department of Neurology, The First Affiliated Hospital of Soochow University, 
      Suzhou, Jiangsu, China.
FAU - Qiu, Youjia
AU  - Qiu Y
AD  - Department of Neurosurgery & Brain and Nerve Research Laboratory, The First 
      Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
FAU - Yin, Ziqian
AU  - Yin Z
AD  - Department of Neurosurgery & Brain and Nerve Research Laboratory, The First 
      Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
FAU - Wang, Zilan
AU  - Wang Z
AD  - Department of Neurosurgery & Brain and Nerve Research Laboratory, The First 
      Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
FAU - Tang, Yanbing
AU  - Tang Y
AD  - Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China.
FAU - Ni, Hanyu
AU  - Ni H
AD  - Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China.
FAU - Lu, Jiaye
AU  - Lu J
AD  - Department of Neurosurgery & Brain and Nerve Research Laboratory, The First 
      Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
FAU - Chen, Zhouqing
AU  - Chen Z
AD  - Department of Neurosurgery & Brain and Nerve Research Laboratory, The First 
      Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
FAU - Kong, Yan
AU  - Kong Y
AD  - Department of Neurology, The First Affiliated Hospital of Soochow University, 
      Suzhou, Jiangsu, China.
FAU - Wang, Zhong
AU  - Wang Z
AD  - Department of Neurosurgery & Brain and Nerve Research Laboratory, The First 
      Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20231108
PL  - Switzerland
TA  - Front Immunol
JT  - Frontiers in immunology
JID - 101560960
RN  - 0 (Antibodies, Monoclonal)
SB  - IM
MH  - Adult
MH  - Humans
MH  - *Antibodies, Monoclonal/adverse effects
MH  - Activities of Daily Living
MH  - Bayes Theorem
MH  - *Myasthenia Gravis/drug therapy
PMC - PMC10663412
OTO - NOTNLM
OT  - B-cell targeting therapy
OT  - FcRn inhibitor
OT  - complement inhibitor
OT  - generalized myasthenia gravis
OT  - meta-analysis
OT  - monoclonal antibody
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2023/11/29 18:43
MHDA- 2023/12/01 06:43
PMCR- 2023/01/01
CRDT- 2023/11/29 15:26
PHST- 2023/08/19 00:00 [received]
PHST- 2023/10/26 00:00 [accepted]
PHST- 2023/12/01 06:43 [medline]
PHST- 2023/11/29 18:43 [pubmed]
PHST- 2023/11/29 15:26 [entrez]
PHST- 2023/01/01 00:00 [pmc-release]
AID - 10.3389/fimmu.2023.1280226 [doi]
PST - epublish
SO  - Front Immunol. 2023 Nov 8;14:1280226. doi: 10.3389/fimmu.2023.1280226. 
      eCollection 2023.