The Security And Effectiveness Of Cyclophosphamide And Mycophenolate Mofetil On The Treatment Of Myasthenia Gravis

Objective: The purpose of the first study is to evaluate the efficacy and safety of cyclophosphamide in the treatment of myasthenia gravis.The purpose of the second study is to evaluate the efficacy and safety of Mycophenolate Mofetil in the treatment of myasthenia gravis.Methods:For the first study,We searched 3 Chinese data base and 4 English data base from inception to January 2018,to collect randomized controlled trials(RCTs)about cyclophosphamide in the treatment of myasthenia gravis by using the keywords ”Myasthenia Gravis,Myasthenia Gravis,Ocular,Ocular Myasthenia Gravis,Myasthenia Gravis,Cyclophosphamide,Cytophosphane,random”.Two reviewers independently screened literature,extracted data and assessed the risk of bias of the included studies.Meta-analysis was performed by using RevMan5.3 software.In order to complete the second study,We searched 4 Chinese data base and 4 English data base from inception to November 2017,to collect randomized controlled trials(RCTs)about Mycophenolate Mofetil in the treatment of myasthenia gravis by using the keywords ”Myasthenia Gravis,Myasthenia Gravis,Ocular,Ocular Myasthenia Gravis,Myasthenia Gravis,Mycophenolic Acid,Mycophenolate Mofetil,random”.Two reviewers independently screened literature,extracted data and assessed the risk of bias of the included studies.Meta-analysis was performed by using RevMan 5.3 software.Results:The first study: 10 RCTs involving 807 myasthenia gravis patients were included.Meta-analysis results indicated that:(1)The effective rate[OR=3.96,95% CI(1.86,8.41),P=0.0003];(2)Myasthenic Crisis [OR=0.20,95% CI(0.10,0.41),P<0.00001];(3)Ventilator time[MD=-2.66,95% CI(-5.31,0.00),P=0.05];(4)Tracheotomy [OR=0.15,95% CI(0.004,0.60),P=0.007];(5)Pulmonary infection [OR=0.13,95% CI(0.08,0.22),P<0.00001];there was no statistical difference in the incidence of adverse events rate.The second study: 5 RCTs involving 376 myasthenia gravis patients were included.Meta-analysis results indicated that: QMGS[MD=-0.85,95% CI(-2.20,0.51),P=0.22]?Ach R-Ab[MD=-0.54,95% CI(-1.67,0.59),P=0.35]?MMT[MD=-1.74,95% CI(-3.71,0.22),P=0.08]?MG-ADL[MD=-0.86,95% CI(-1.59,-0.12),P=0.02]?Mental component score[MD=-0.51,95% CI(-2.88,1.86),P=0.67]?Physical component score[MD= 1.21,95%CI(-1.01,3.42),P=0.29],there was no statistical difference in the incidence of adverse events rate.Conclusion:The application of cyclophosphamide can polish up the final result of myasthenia gravis,and the treatment of Mycophenolate Mofetil does not improve the score of QMGS?AchR-Ab?MMT?SF-36 in myasthenia gravis,but both of them have a tolerable adverse reactions.