Innovative new therapies, such as anticomplement and neonatal Fc receptor (FcRn) blockers, are effective treatments for myasthenia gravis (MG), according to the results of a systematic review and meta-analysis published in the European Journal of Neurology.
Combining the results of all studies showed that patients who received anticomplement or antiFcRn had a significant overall mean change of -2.17 points on the MG-Activities of Daily Living (MG-ADL) scale (P <.001) compared to patients who only received placebo.
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Significant overall effects were also observed for the Quantitative MG (QMG), MG-Composite (MGC), and the MG Quality of Life 15-item (MG-QoL15) scales (P <.001 for each) for patients who received innovative therapies compared to those who received placebo.
Subanalysis comparing anticomplement and antiFcRn treatments did not find a significant difference between the 2 treatments in MG-ADL scores (mean difference [MD], -1.88 vs -2.61, respectively; P =.16).
However, antiFcRn treatments did show greater improvement compared to anticomplement treatments in QMG scores (-3.46 vs -2.60; P <.001) and MGQoL-15 scores (-.84 vs -.37; P =.01). A higher improvement in MGC was also observed for antiFcRn treatments compared to anticomplement but the difference was not significant (-5.12 vs -3.24; P =.12).
The meta-analysis also included phase 2 studies using rituximab therapy and found that it did not yield significant improvements in any of the 4 outcome measures when compared to placebo.
“Anticomplement and FcRn treatments both proved to be effective in MG patients, whereas rituximab did not show a significant benefit for patients,” the authors wrote.
In subsequent network meta-analysis comparing individual treatments, efgartigimod had the highest probability of being the best treatment (62.6%) followed by 10 mg of rozanolixizumab (34.0%) based on QMG scores. When estimating the best treatment based on MG-ADL, efgartigimod and rozanolixizumab at 10 mg and 7 mg doses had the highest probabilities to be the best treatment (31.5%, 28.1%, and 20.6%, respectively).
“We found a greater response for antiFcRn treatment at the QMG, but since this is the first report in this direction, the findings should be prudently interpreted and confirmed in larger cohorts or through real-life comparisons.”
A total of 7 randomized, controlled studies were included in the meta-analysis and comprised 502 treated patients and 439 patients receiving placebo.
Reference
Saccà F, Pane C, Espinosa PE, et al. Efficacy of innovative therapies in myasthenia gravis: a systematic review, meta-analysis and network meta-analysis. Eur J Neurol. Published online May 19, 2023. doi:10.1111/ene.15872
