Comparing Efficacy and Safety of Various Monoclonal Antibodies in Myasthenia Gravis: A Systematic Review and Network Meta‐Analysis of Randomized Controlled Trials

Journal article : Review

Background: Myasthenia gravis (MG) is an autoimmune disorder that causes muscle weakness due to disrupted neuromuscular transmission. This network meta‐analysis compared the safety and effectiveness of monoclonal antibodies used to treat MG. Methods: PubMed, Cochrane Central, and ScienceDirect were searched through June 2025. A frequentist network meta‐analysis was conducted using the “meta” and “netmeta” packages in RStudio version 4.3.3. Treatment rankings were determined by p‐scores. Results: Eighteen randomized controlled trials (RCTs) were included in this network meta‐analysis. Rozanolixzumab (ROZ) 10 mg/kg significantly decreased the MG Activities of Daily Living (MG‐ADL) score compared to placebo (MD = −2.33; 95%CI:[‐3.60, −1.06]; p = 0.0003) and was ranked best (p‐score = 0.77) regarding this outcome. Batoclimab (BAT) 680 mg significantly reduced the Quantitative MG (QMG) score compared to placebo (MD = ‐5.17; 95%CI:[‐6.44, ‐3.89]; p <0.0001) and was rated the top performer (p‐score = 0.96) for this endpoint. Regarding the MG Composite (MGC) score, BAT 340 mg was ranked best (p‐score = 0.82), although the decrease in MGC score was insignificant (MD −5.30; 95%CI:[−11.01, 0.41]; p = 0.07). Eculizumab (ECU) was ranked best (p‐score = 0.93) regarding the 15‐item revised MG Quality of Life (MG‐QoL 15r) score. Belimumab (BEL) 10 mg/kg was ranked best regarding the adverse events (p‐score = 0.87). Conclusion: ROZ 10 mg/kg ranked best for MG‐ADL. BAT 680 mg significantly reduced QMG and ranked best. BAT 340 mg had the highest probability of reducing the MGC score. ECU significantly decreased MG‐QoL 15r and ranked best. BEL 10 mg/kg had the highest likelihood of reducing adverse events.

Authors: Waseem, MH; Abideen, ZU; Iqbal, M; Ishtiaq, S; Thada, PK

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Wiley
• Journal: Brain and Behavior
• Volume: 16
• Issue: 6
• Article number: e71557
• Publication date: 2026-06-16
• DOI: 10.1002/brb3.71557
• ISSN: 2162-3279
• Language: English
• Keywords: monoclonal antibodies; myasthenia gravis; complement inhibitor; network meta‐analysis; FcRn inhibitor
• Subtype: Review