$Efficacy and Safety of Immunotherapies in Refractory Myasthenia Gravis: A Systematic Review and Meta-Analysis$
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Efficacy and Safety of Immunotherapies in Refractory Myasthenia Gravis: A Systematic Review and Meta-Analysis

Introduction: Approximately 10–20% of patients WITH myasthenia gravis (MG) are refractory to conventional immunotherapies. The purpose of this study was to conduct a systematic review and meta-analysis to explore the optimal therapies for refractory MG.Method: Correlative studies were performed thro...

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Autores principales:	Xuelin Feng, Zubiao Song, Mengli Wu, Yanmei Liu, Sushan Luo, Chongbo Zhao, Weixi Zhang
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	refractory myasthenia gravis immunotherapies tacrolimus eculizumab (monoclonal antibody to C5) rituximab-ofatumumab-ibrutinib-idelalisib Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/7271f06cc9e1455cada1fd974c4fdddf
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spelling	oai:doaj.org-article:7271f06cc9e1455cada1fd974c4fdddf2021-12-02T00:55:27ZEfficacy and Safety of Immunotherapies in Refractory Myasthenia Gravis: A Systematic Review and Meta-Analysis1664-229510.3389/fneur.2021.725700https://doaj.org/article/7271f06cc9e1455cada1fd974c4fdddf2021-12-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fneur.2021.725700/fullhttps://doaj.org/toc/1664-2295Introduction: Approximately 10–20% of patients WITH myasthenia gravis (MG) are refractory to conventional immunotherapies. The purpose of this study was to conduct a systematic review and meta-analysis to explore the optimal therapies for refractory MG.Method: Correlative studies were performed through a search in PubMed, Cochrane Library, and Embase databases. The primary outcome was defined by changes in the quantitative myasthenia gravis score (QMG). Secondary outcomes were defined by the Myasthenia Gravis Activities of Daily Living Scale (MG-ADL), Myasthenia Gravis Foundation of America (MGFA) post intervention status, adverse events, and disease exacerbation after treatment.Result: A total of 16 studies were included with 403 patients with refractory MG on therapies with rituximab, eculizumab, tacrolimus, and cladribine. Therapeutic efficacy of rituximab and eculizumab was identified with an estimated reduction in QMG score (4.158 vs. 6.928) and MG-ADL (4.400 vs. 4.344), respectively. No significant changes were revealed in efficacy or exacerbation density between the two independent therapeutic cohorts. The estimated adverse event density of eculizumab was more significant than that in the rituximab group (1.195 vs. 0.134 per patient-year), while the estimated serious event density was similar.Conclusion: The efficacy and safety of rituximab and eculizumab have been approved in patients with refractory MG. Rituximab had a superior safety profile than eculizumab with a lower incidence of adverse events.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021236818, identifier CRD42021236818.Xuelin FengXuelin FengZubiao SongMengli WuYanmei LiuSushan LuoChongbo ZhaoWeixi ZhangFrontiers Media S.A.articlerefractory myasthenia gravisimmunotherapiestacrolimuseculizumab (monoclonal antibody to C5)rituximab-ofatumumab-ibrutinib-idelalisibNeurology. Diseases of the nervous systemRC346-429ENFrontiers in Neurology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	refractory myasthenia gravis immunotherapies tacrolimus eculizumab (monoclonal antibody to C5) rituximab-ofatumumab-ibrutinib-idelalisib Neurology. Diseases of the nervous system RC346-429
spellingShingle	refractory myasthenia gravis immunotherapies tacrolimus eculizumab (monoclonal antibody to C5) rituximab-ofatumumab-ibrutinib-idelalisib Neurology. Diseases of the nervous system RC346-429 Xuelin Feng Xuelin Feng Zubiao Song Mengli Wu Yanmei Liu Sushan Luo Chongbo Zhao Weixi Zhang Efficacy and Safety of Immunotherapies in Refractory Myasthenia Gravis: A Systematic Review and Meta-Analysis
description	Introduction: Approximately 10–20% of patients WITH myasthenia gravis (MG) are refractory to conventional immunotherapies. The purpose of this study was to conduct a systematic review and meta-analysis to explore the optimal therapies for refractory MG.Method: Correlative studies were performed through a search in PubMed, Cochrane Library, and Embase databases. The primary outcome was defined by changes in the quantitative myasthenia gravis score (QMG). Secondary outcomes were defined by the Myasthenia Gravis Activities of Daily Living Scale (MG-ADL), Myasthenia Gravis Foundation of America (MGFA) post intervention status, adverse events, and disease exacerbation after treatment.Result: A total of 16 studies were included with 403 patients with refractory MG on therapies with rituximab, eculizumab, tacrolimus, and cladribine. Therapeutic efficacy of rituximab and eculizumab was identified with an estimated reduction in QMG score (4.158 vs. 6.928) and MG-ADL (4.400 vs. 4.344), respectively. No significant changes were revealed in efficacy or exacerbation density between the two independent therapeutic cohorts. The estimated adverse event density of eculizumab was more significant than that in the rituximab group (1.195 vs. 0.134 per patient-year), while the estimated serious event density was similar.Conclusion: The efficacy and safety of rituximab and eculizumab have been approved in patients with refractory MG. Rituximab had a superior safety profile than eculizumab with a lower incidence of adverse events.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021236818, identifier CRD42021236818.
format	article
author	Xuelin Feng Xuelin Feng Zubiao Song Mengli Wu Yanmei Liu Sushan Luo Chongbo Zhao Weixi Zhang
author_facet	Xuelin Feng Xuelin Feng Zubiao Song Mengli Wu Yanmei Liu Sushan Luo Chongbo Zhao Weixi Zhang
author_sort	Xuelin Feng
title	Efficacy and Safety of Immunotherapies in Refractory Myasthenia Gravis: A Systematic Review and Meta-Analysis
title_short	Efficacy and Safety of Immunotherapies in Refractory Myasthenia Gravis: A Systematic Review and Meta-Analysis
title_full	Efficacy and Safety of Immunotherapies in Refractory Myasthenia Gravis: A Systematic Review and Meta-Analysis
title_fullStr	Efficacy and Safety of Immunotherapies in Refractory Myasthenia Gravis: A Systematic Review and Meta-Analysis
title_full_unstemmed	Efficacy and Safety of Immunotherapies in Refractory Myasthenia Gravis: A Systematic Review and Meta-Analysis
title_sort	efficacy and safety of immunotherapies in refractory myasthenia gravis: a systematic review and meta-analysis
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/7271f06cc9e1455cada1fd974c4fdddf
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Efficacy and Safety of Immunotherapies in Refractory Myasthenia Gravis: A Systematic Review and Meta-Analysis

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