{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T17:27:58Z","timestamp":1791912478197,"version":"4.3.4"},"reference-count":42,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T00:00:00Z","timestamp":1685404800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>Therapy for myasthenia gravis (MG) is undergoing a profound change, with new treatments being tested. These include complement inhibitors and neonatal Fc receptor (FcRn) blockers. The aim of this study was to perform a meta\u2010analysis and network meta\u2010analysis of randomized and placebo\u2010controlled trials of innovative therapies in MG with available efficacy data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We assessed statistical heterogeneity across trials based on the Cochrane Q test and <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> values, and mean differences were pooled using the random\u2010effects model. Treatment efficacy was assessed after 26\u2009weeks of eculizumab and ravulizumab, 28\u2009days of efgartigimod, 43\u2009days of rozanolixizumab, 12\u2009weeks of zilucoplan, and 16, 24 or 52\u2009weeks of rituximab treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We observed an overall mean Myasthenia Gravis\u2010Activities of Daily Living scale (MG\u2010ADL) score change of \u22122.17 points (95% confidence interval [CI] \u22122.67, \u22121.67; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) as compared to placebo. No significant difference emerged between complement inhibitors and anti\u2010FcRn treatment (<jats:italic>p<\/jats:italic>\u2009=\u20090.16). The change in Quantitative Myasthenia Gravis scale (QMG) score was \u22123.46 (95% CI \u22124.53, \u22122.39; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), with a higher reduction with FcRns (\u22124.78 vs. \u22122.60; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Rituximab did not significantly improve the MG\u2010ADL (\u22120.92 [95% CI \u22122.24, 0.39]; <jats:italic>p<\/jats:italic>\u2009=\u20090.17) or QMG scores (\u22121.9 [95% CI \u22123.97, 0.18]; <jats:italic>p<\/jats:italic>\u2009=\u20090.07). In the network meta\u2010analysis, efgartigimod had the highest probability of being the best treatment, followed by rozanolixizumab.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Anti\u2010complement and FcRn treatments both proved to be effective in MG patients, whereas rituximab did not show a significant benefit for patients. Within the limitations of this meta\u2010analysis, including efficacy time points, FcRn treatments showed a greater effect on QMG score in the short term. Real\u2010life studies with long\u2010term measurements are needed to confirm our results.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.15872","type":"journal-article","created":{"date-parts":[[2023,5,19]],"date-time":"2023-05-19T10:49:07Z","timestamp":1684493347000},"page":"3854-3867","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":79,"title":["Efficacy of innovative therapies in myasthenia gravis: A systematic review, meta\u2010analysis and network meta\u2010analysis"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1323-6317","authenticated-orcid":false,"given":"Francesco","family":"Sacc\u00e0","sequence":"first","affiliation":[{"name":"Department of Neurosciences and Reproductive and Odontostomatological Sciences University \u201cFederico II\u201d  Naples 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