Monoclonal Antibodies Had Varying Efficacy in Treating MG

The treatment of myasthenia gravis (MG) relies on the efficacy of monoclonal antibodies, but some are more effective than others. A meta-analysis published in Brain and Behavior compared the efficacy of different monoclonal antibodies when used to treat MG,¹ specifically in how the MG Activities of Daily Living (MG-ADL) score changed with different treatments.

MG is an autoimmune neuromuscular disorder that causes skeletal muscle weakness and is primarily caused by IgG autoantibodies targeting the acetylcholine receptor, muscle-specific kinase, or low-density lipoprotein receptor-related protein 4.² Corticosteroids, nonsteroidal immunosuppressants, and cholinesterase inhibitors are all used to treat MG, with monoclonal antibodies also becoming a part of the treatment regimen. This review aimed to assess data from randomized controlled trials to compare the efficacy and safety of different monoclonal antibodies used in the treatment of MG.¹

The researchers searched ScienceDirect, PubMed, and Cochrane Library to find studies for the review. Studies were included if the participants were all aged 18 years or older and had a confirmed diagnosis of generalized MG. Studies that reported at least 1 of the MG-ADL, Quantitative MG (QMG), MG Composite (MGC), or revised MG Quality of Life (MG-QoL 15r) scores were included, and only randomized controlled trials were considered.

There were 18 studies included in the final systematic review, which were published between 2017 and 2025. The mean age in the studies ranged from 36 to 67 years. The monoclonal antibodies that were tested in these studies included batoclimab (BAT), rozanolixzumab (ROZ), efgartigimod, rituximab, eculizumab (ECU), and belimumab (BEL), among others.

The MG-ADL score was reduced in all of those who took BAT 340 mg, BAT 680 mg, ECU, inebilizumab (INE), nipocalimab (NIP) 30/15 mg/kg, ravulizumab (RAV), ROZ 10 mg/kg, ROZ 7 mg/kg, satralizumab (SAT), and zilcoplan (ZIL), with remaining studies finding that placebo was comparable to all other monoclonal antibodies in this end point. ROZ 10 mg/kg was found to be the best (mean difference [MD], –2.33; 95% CI, –3.60 to –1.06), whereas NIP 60 mg/kg was found to be the worst.

BAT 340 mg, BAT 680 mg, ECU, INE, NIP 30/15 mg/kg, RAV, SAT, and ZIL 0.3 mg/kg all significantly decreased the QMG score, whereas NIP 60 mg/kg increased the QMG score. BAT 680 mg was ranked the best (MD, –5.17; 95% CI, –6.44 to –3.89), whereas NIP 60 mg/kg ranked the worst (MD, 2.20; 95% CI, 0.13-4.27).

ECU, SAT, and ZIL were able to significantly reduce the MGC score. BAT 340 mg, BAT 680 mg, ECU, NIP 30 mg/kg, ZIL 0.1 mg/kg, and ZIL 0.3 mg/kg all were able to reduce the MG-QoL 15r score. ECU was ranked the best (MD, –7.10; 95% CI, –11.53 to –2.67), whereas the NIP 60 mg/kg dose was ranked the worst. Only SAT increased the number of adverse events experienced by patients (RR, 1.23; 95% CI, 1.07-1.42).

There were some limitations to this study. There were small sample sizes within each of the trials, which could have affected results. Indirect comparisons were used throughout the analysis, which minimized any direct comparisons. There was no subgroup analysis by serotype of MG. Heterogeneity could have acted as a potential confounder. Outcome measures were different throughout the trials. Only 1 product from each biological class is usually available in clinical settings, limiting the generalizability of these findings.

ROZ 10 mg/kg, BAT 680 mg, BAT 340 mg, and ECU were able to reduce the MG-ADL score, QMG score, MGC score, and MG-QoL 15r score, respectively. “No single monoclonal antibody demonstrates superiority across all domains…underscoring the importance of individualized therapy guided by patient-specific priorities, including symptom burden, tolerability, and quality of life,” the authors concluded.

References

1. Waseem MH, ul Abideen Z, Iqbal M, Ishtiaq S, Thada PK, Dmytriw AA. Comparing efficacy and safety of various monoclonal antibodies in myasthenia gravis: a systematic review and network meta-analysis of randomized controlled trials. Brain Behav. 2026;16(6):e71557. doi:10.1002/brb3.71557
2. Myasthenia gravis. Cleveland Clinic. Updated November 10, 2023. Accessed June 18, 2026. https://my.clevelandclinic.org/health/diseases/17252-myasthenia-gravis-mg