Objective:

To assess the relative effectiveness of immunomodulatory treatments for generalized myasthenia gravis (gMG).

Background:

Several novel therapies have recently been approved in the United States for gMG, while inebilizumab and nipocalimab are either currently under FDA review or expected to undergo evaluation. Comparative evaluations of these treatments are necessary for guiding informed clinical decision-making.

Design/Methods:

A Bayesian network meta-analysis NMA was conducted to compare the efficacy of neonatal Fc receptor inhibitors (efgartigimod intravenous [IV], rozanolixizumab) and complement inhibitors (ravulizumab, zilucoplan) versus placebo. Efficacy outcomes included changes from baseline,  and ≥3- and ≥5-point reductions in MG-ADL and QMG scores. Number needed to treat (NNT) versus placebo were derived from NMA outputs. The analysis will be updated to include inebilizumab and nipocalimab as new data becomes available.

Results:

The NMA results suggest efgartigimod IV was associated with the greatest improvement in changes from baseline in MG-ADL (not significantly better than other active treatments) and QMG (significantly better than ravulizumab and zilucoplan). Efgartigimod IV also had the lowest NNT vs. placebo for achieving ≥5-point reduction in MG-ADL and ≥3-point reductions in QMG (significantly lower vs. ravulizumab and zilucoplan), and ≥5-point reduction in QMG (significantly lower than zilucoplan). Rozanolixizumab had the lowest NNT for ≥3-point reduction in MG-ADL (not statistically lower than other active treatments). The poster will present updated results incorporating nipocalimab and inebilizumab. 

Conclusions:

Fc receptor inhibitors, particularly efgartigimod IV, show a more favorable efficacy profile compared to ravulizumab and zilucoplan. Further results, including data on nipocalimab and inebilizumab, will be presented in updates to the analysis.