Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
Department of Neurology, Jing'an District Centre Hospital of Shanghai, Fudan University, Shanghai, China.
CNS Neurosci Ther. 2019 May;25(5):647-658. doi: 10.1111/cns.13110. Epub 2019 Feb 26.
We intended to compare and rank all the immunotherapies including immunosuppressant agents or monoclonal antibodies for myasthenia gravis (MG).
A network meta-analysis was performed to synthesize the direct evidence and indirect evidence. Quantitative MG score (QMGS) was defined as the primary outcome. The secondary outcomes included the glucocorticoid reduction and hazard ratios (HR) from the counts of adverse events (AEs).
We identified 14 studies including 808 MG patients. For the primary outcome, cyclosporine A (CsA) was hierarchically the best with statistical significances of -1.18 (-1.81, -0.59) vs placebo (PLA), -0.98 (-1.72, -0.23) vs mycophenolate mofetil, and -0.77 (-1.57, -0.032) vs tacrolimus (TAC). When the intervention periods were controlled, both eculizumab (ECZ) of -1.50 (-2.81, -0.18) and CsA of -1.23 (-1.81, -0.64) vs PLA reached a statistical significance. Belimumab and ECZ ranked the most tolerable therapies while CsA of 2.41 (0.58, 10.01) ranked the last vs PLA.
These findings demonstrated that ECZ represented the most effective and tolerable therapeutic alternative to be recommended for refractory MG. TAC may be a beneficial therapy to treat MG extensively while the efficacy of CsA and cyclophosphamide may be limited by their multiple or severe AEs.
我们旨在比较和排名所有免疫疗法，包括免疫抑制剂或单克隆抗体，用于重症肌无力（MG）。
进行网络荟萃分析以综合直接证据和间接证据。定量肌无力评分（QMGS）定义为主要结局。次要结局包括糖皮质激素减少和来自不良事件（AE）计数的风险比（HR）。
我们确定了 14 项研究，包括 808 例 MG 患者。对于主要结局，环孢素 A（CsA）在统计学上具有显著意义，分别优于安慰剂（PLA）-1.18（-1.81，-0.59），优于霉酚酸酯-0.98（-1.72，-0.23），优于他克莫司-0.77（-1.57，-0.032）。当干预期得到控制时，依库珠单抗（ECZ）-1.50（-2.81，-0.18）和 CsA-1.23（-1.81，-0.64）均与 PLA 相比具有统计学意义。贝利尤单抗和 ECZ 排名最耐受的疗法，而 CsA 2.41（0.58，10.01）与 PLA 相比排名最后。
这些发现表明，ECZ 代表了最有效和最耐受的治疗选择，可推荐用于难治性 MG。TAC 可能是一种广泛治疗 MG 的有益疗法，而 CsA 和环磷酰胺的疗效可能受到其多种或严重 AE 的限制。
Zotero 插件
