Meta Analysis Of Immunosuppressive Agents In The Treatment Of Myasthenia Gravis

Objective: the efficacy of immunosuppressive agents in the treatment of patients with myasthenia gravis has not yet reached a consensus.In order to further make clear the effect of immunosuppressive agents in patients with myasthenia gravis,we will conduct a systematic review and meta-analysis to make sure whether it can reduce the amount of corticosteroids,the disease severity score,and antibody concentration in patients with myasthenia gravis.Methods: Using the PICOS principle,we searched the China Nationgal Knowledge Insfrastructure(CNKI),Wanfang database,VIP database(VIP),China biomedical database(CBM),The Cochrane Library,Pubmed,Embase for Chinese and English literature on immunosuppressive therapy for myasthenia gravis.We arranged the literatures using Yixuewenxianwang software,and carefully reviewed the title and abstract,excluding those literatures which are obviously not relevant,and then we made appropriate inclusion and exclusion criteria,making preliminary screening according to the criteria,the acquired literatures can further be downloaded for full text,next we made a data information collection table,and read the text carefully,collecting data relevant to the study,then we used the bias risk assessment tools provided by the Cochrane collaboration to evaluate the quality of literatures.We Selected the weighted mean difference(Weighted mean difference,WMD)as the effect scale,at the sixth months or twelfth months of the treatment,we made meta-analysis by Revman software on prednisone or prednisolone dosage,serum anti acetylcholine receptor antibody(Acetylcholine receptor antibody,ACh R-Ab)concentration,quantitative myasthenia gravis score(QMG),MG-activities of daily living profile(MG-ADL),MG manual musde test(MG-MMT),the results were shown by forest plot.Results: 2106 articles were retrieved,finally 10 articles were included,of which 9 papers for English literature,1 articles for Chinese literature,including: mycophenolate mofetil 3,tacrolimus 3,cyclosporine 2,cyclophosphamide 1,methotrexate,1.A total of 531 patients with myasthenia gravis were enrolled in this study.There were 270 patients in the experimental group and the other in the observation group(n = 261).Meta analysis results: at the sixth month,immunosuppressant and placebo steroid dosage Z = 3.63,P = 0.0003,the difference was statistically significant at the twelfth month,two groups of steroid dosage Z = 1.87,P = 0.06,the difference was not statistically significant,at the sixth month,there was no statistically significant difference between the two groups in QMG score(P = 0.10),MG-ADL score(P = 0.07),MMT score(P = 0.08),serum ACh R-Ab concentration(P = 0.09),at the twelfth month,there was no significant difference between of the two groups in QMG scores(P = 0.60),subgroup analysis results showed that: at the sixth month,tacrolimus can reduce steroid dosage in patients with myasthenia gravis(P = 0.007),mycophenolate mofetil can reduce MG patients serum ACh R-Ab concentration(P = 0.32).Conclusion: immunosuppressive agents can reduce the dosage of steroid in patients with MG,which has the effect of " steroid saving",but this effect is obvious at the sixth month,and disappears at the twelfth month.Tacrolimus can reduce dosage steroid dosage in MG patients.although Immunosuppressive therapy can not improve the strength level,increase muscular endurance,improve motor function and quality of life,but it can effectively control the symptoms of MG patients,the disease is no longer continue to progress.Immunosuppressive agents can not reduce serum ACh R-Ab concentration in patients with MG.Mycophenolate mofetil can not reduce serum ACh R-Ab concentration in patients with MG.