{"doi":"10.1002/14651858.cd013801.pub2","title":"Immunoglobulin for myasthenia gravis","abstract":"RATIONALE: Immunoglobulin has long been used to treat neuroimmunological conditions, including myasthenia gravis (MG). However, the evidence supporting its benefits in MG remains uncertain. OBJECTIVES: To assess the benefits and harms of immunoglobulin in people with generalized MG. Specifically, we aimed to compare 1) intravenous immunoglobulin (IVIg) versus subcutaneous immunoglobulin (SCIg), and 2) immunoglobulin administered via either route (irrespective of treatment duration, dosage, and regimen) versus no treatment, placebo, plasma exchange (PLEX), corticosteroids, acetylcholinesterase inhibitors, or any other treatment. SEARCH METHODS: On 17 September 2024, we searched the Cochrane Neuromuscular's Specialised Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and ClinicalTrials.gov. We also searched the World Health Organization's International Clinical Trials Registry Platform to May 2022. Additionally, we reviewed the references of included studies. ELIGIBILITY CRITERIA: We included parallel and cross-over randomized controlled trials (RCTs) comparing IVIg with SCIg or immunoglobulin versus other interventions in participants with acute exacerbations or chronic active MG, undergoing steroid tapering, or preparing for surgery. We excluded trials without a comparison group. OUTCOMES: We measured critical outcomes over three time intervals: short-term (up to two weeks), medium-term (2 to 24 weeks), and long-term (beyond 24 weeks). They included physician-evaluated change in severity of symptoms and signs, measured by scales such as the Quantitative Myasthenia Gravis (QMG) score and the Myasthenia Muscle Score (MMS); patient-reported change in functional capacity, measured by scales such as the MG Activities of Daily Living (MG-ADL) scale, the MG Quality of Life (MG-QOL), and MG-QOL15 questionnaire, and change in measures that incorporate both physician-evaluated and patient-reported items, such as the Myasthenia Gravis Composite (MGC) scale. Prioritized important outcomes were length of hospitalization, incidence of MG-related hospitalizations, and specific treatment-related adverse events. RISK OF BIAS: We used the risk of bias 2 (RoB 2) tool (and its extension for cross-over trials) to assess the risk of bias. SYNTHESIS METHODS: We conducted meta-analyses for each of the possible comparisons using a random-effects model when different scales were used for the measurement of the same outcome or when studies in an analysis included different types of participants. We calculated mean differences (MDs) or standardized mean differences (SMDs) for continuous outcomes, and risk differences (RDs) for dichotomous outcomes, with 95% confidence intervals (CIs). We used GRADE to assess the certainty of evidence. INCLUDED STUDIES: We included 12 RCTs (11 with usable data; 515 participants) conducted between 1997 and 2025 in Europe, North America, and Asia. All studies assessed IVIg; none assessed SCIg. Comparators included PLEX (six trials), placebo (five trials), and corticosteroids (one trial). SYNTHESIS OF RESULTS: = 81%; 2 studies, 124 participants; very low-certainty evidence). We found no difference in patient-reported short-term change in functional capacity. We found no data for combined measures (e.g. MGC). IVIg was associated with longer hospital stays than PLEX (MD 2.90, 95% CI 2.58 to 3.22; 1 study, 40 participants; low-certainty evidence), while no MG-related hospitalizations occurred. No significant differences were found in adverse events, including hypotension requiring vascular expansion, and headache. Immunoglobulin versus corticosteroids We observed no difference between IVIg and corticosteroids in physician-evaluated short-term change in symptom severity, assessed with the QMG score (MD -0.66, 95% CI -2.58 to 1.26; 1 study, 33 participants; very low-certainty evidence). No data were available for patient-reported changes in functional capacity, combined measures, length of hospitalizatio","journal":"Cochrane Database of Systematic Reviews","year":2025,"id":578069,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9618,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":447416,"name":"Muayad Alzuabi","orcid":"0000-0002-2748-3474","position":1,"is_corresponding":false},{"id":1487764,"name":"Amjad Elmashala","orcid":"0000-0001-7345-4044","position":2,"is_corresponding":false},{"id":1488134,"name":"Jennifer Cashwell","orcid":null,"position":3,"is_corresponding":false},{"id":614203,"name":"Mohammed Murad","orcid":"0000-0001-8546-2121","position":4,"is_corresponding":false},{"id":656433,"name":"Elie Naddaf","orcid":"0000-0001-6212-1236","position":5,"is_corresponding":false},{"id":1025319,"name":"Apostolos Manolopoulos","orcid":"0000-0003-1055-0324","position":0,"is_corresponding":true}],"reference_count":68,"raw_metadata":null,"created_at":"2026-07-19T02:58:20.638044Z","pmid":"41090479","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}