Comparison of the Efficacy and Safety of Myasthenia Gravis Treatments: A Bayesian Network Meta-Analysis.

To assist clinicians in navigating this complex treatment landscape, we sought to compare treatments while accounting for differences in trial populations.

为了帮助临床医生在这一复杂的治疗领域中导航，我们试图在考虑试验人群差异的情况下比较各种治疗方法。

Methods

We conducted a Bayesian network meta-analysis(PROSPERO ID: CRD42023428733) of MG treatments.

我们进行了一项贝叶斯网络荟萃分析（PROSPERO ID: CRD42023428733），研究重症肌无力（MG）的治疗方法。

We searched Scopus, Embase, Web of Science, CENTRAL, and MEDLINE up to May 2, 2025, for randomized trials in MG.

我们检索了Scopus、Embase、Web of Science、CENTRAL和MEDLINE数据库，直到2025年5月2日，以寻找重症肌无力（MG）的随机试验。

Two independent reviewers (N.M. and M.R.) identified prospective multiarm studies of adults (18 or older) with generalized MG that reported mean treatment difference, with uncertainty, in MG-Activities of Daily Living (MG-ADL) or Quantitative MG (QMG) score change from baseline.

两位独立评审员（N.M. 和 M.R.）识别出针对成年（18岁或以上）全身型肌无力患者的前瞻性多臂研究，这些研究报告了从基线开始的MG- 日常生活活动（MG-ADL）或定量肌无力（QMG）评分变化的平均治疗差异，以及不确定性的表达。

Results

Of 4,823 eligible studies, 27 placebo-controlledrandomized trials (placebo n = 1,086; treatment n = 1,232) were included that targeted B cells, neonatal Fc receptor (FcRn), complement activity, CD40, and interleukin-6 signaling, as well as immunoglobulin G and broad immunosuppression therapy.

在4,823项符合条件的研究中，纳入了27项安慰剂对照的随机试验（安慰剂组n=1,086；治疗组n=1,232），这些试验针对B细胞、新生儿Fc受体（FcRn）、补体活性、CD40和白细胞介素-6信号传导，以及免疫球蛋白G和广谱免疫抑制治疗。

Compared to those treated with placebo and standard of care, QMG scores decreased by an average of -3.63 (95% credible interval -4.43 to -2.77) points more in patients treated with FcRn inhibitors, -2.59 (-3.92 to -1.28) points more in patients treated with C5 complement inhibitors (C5i), and -2.50 (-5.11 to 0.12) points more in patients treated with CD19+ B-cell depletion therapy (BCDT).

与接受安慰剂和标准治疗的患者相比，接受FcRn抑制剂治疗的患者的QMG评分平均下降了-3.63（95%可信区间-4.43至-2.77）点，接受C5补体抑制剂（C5i）治疗的患者下降了-2.59（-3.92至-1.28）点，接受CD19+ B细胞耗竭治疗（BCDT）的患者下降了-2.50（-5.11至0.12）点。

The MG-ADL treatment effects were -1.93 (-2.21 to -1.65) for FcRn inhibitors, -1.84 (-2.48 to -1.19) for C5i, and -1.91 (-2.97 to -0.84) for CD19+ BCDT.

MG-ADL治疗效果为FcRn抑制剂-1.93（-2.21至-1.65），C5i为-1.84（-2.48至-1.19），CD19+ BCDT为-1.91（-2.97至-0.84）。

Sensitivity analyses detected potential confounding of treatment effects by age and sex.

敏感性分析检测到年龄和性别可能对治疗效果产生混杂影响。

Patients treated with FcRn inhibitors had greater odds of treatment-related adverse events (odds ratio 2.20 [1.52-3.38]) compared with the placebo group, while C5i and CD19+ BCDT showed odds comparable to placebo.

接受FcRn抑制剂治疗的患者出现与治疗相关的不良事件的几率更高（比值比为2.20 [1.52-3.38]），与安慰剂组相比，而C5i和CD19+ BCDT的几率与安慰剂相当。

Discussion

FcRn inhibitors, C5i, and CD19+ BCDT showed comparable efficacy in terms of QMG and MG-ADL reduction because meaningful differences were not observed between treatment classes.

FcRn抑制剂、C5i和CD19+ BCDT在QMG和MG-ADL降低方面显示出相似的疗效，因为治疗类别之间未观察到有意义的差异。

Our findings also highlight how differences between trial populations may confound the interpretation of study outcomes.

我们的发现还强调了试验人群之间的差异如何可能混淆研究结果的解释。

Prospective comparative efficacy studies are warranted.

有必要进行前瞻性的比较疗效研究。