Efficacy and Safety of Targeted Therapies for Myasthenia Gravis: A Network Meta-analysis of Randomized Clinical Trials
Abdallah Abunamoos1, Bara Hammadeh2, Fares Qtaishat1, Mohammad Mustafa1, Fawzi Alnajjar1, Mohammad Alghaniem1, Yumna Aljazi1, Abdelkader Rababah1, Dana Suboh1, Naser Alkasasbeh1, Raseel Massad1
1The University of Jordan, 2Al-Balqa' Applied University
Objective:
To compare the efficacy and safety of targeted biologic and immunomodulatory therapies in adult patients with gMG through a Bayesian network meta-analysis (NMA). 
Background:

Generalized myasthenia gravis (gMG) is a chronic autoimmune neuromuscular disorder. Despite conventional therapies, 10–20% of patients remain refractory or intolerant, prompting interest in biologics targeting key immunologic pathways.

 
Design/Methods:

A comprehensive search was conducted on PubMed, Scopus, and Embase up to February 9, 2025, for randomized controlled trials (RCTs) assessing biologic therapies in gMG. A Bayesian hierarchical model using SUCRA was implemented for treatment ranking. Outcomes included MG-ADL, QMG, MGC, MG-QoL15r, IgG reduction, and adverse events (AEs).

 
Results:

Nineteen RCTs with 1,807 participants were included. Rozanolixizumab ranked highest for MG-ADL (SUCRA 92.1%), QMG (75.1%), and MGC (85.4%) improvement but had a less favorable safety profile. Eculizumab ranked highest for MG-QoL15r improvement (91.8%) and demonstrated the best AE/SAE profile. Zilucoplan performed well across QMG (74.5%) and MG-QoL15r (64.9%). Batoclimab showed credible QMG improvement over placebo (MD: +4.912; 95% CrI: 0.250–8.858). Peripheral edema was the only AE significantly more common with active treatment (OR: 10.33; 95% CI: 3.75–28.47). No intervention demonstrated statistically significant superiority in IgG reduction. Eculizumab, iscalimab, and belimumab showed the most favorable safety profiles.

 
Conclusions:
Rozanolixizumab and zilucoplan are promising for rapid symptom relief, while eculizumab offers durable benefit with high tolerability. Iscalimab and belimumab provide safer alternatives for select populations. These findings support a stratified, patient-tailored approach to biologic therapy in gMG.
Generative AI Usage
No, did not use generative AI in the drafting or editing in this abstract.
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