This network meta-analysis aims to compare the safety and effectiveness of various doses of monoclonal antibodies used in Myasthenia Gravis (MG) treatment.

 MG is an autoimmune disorder that causes muscle weakness due to disrupted synaptic transmission. Several monoclonal antibodies have been developed to treat MG.

PubMed, Cochrane Central, and ScienceDirect were searched through June 2025. A frequentist network meta-analysis was conducted using the "meta” and “netmeta” packages in RStudio version 4.3.3. Treatment rankings were determined by p-scores. Risk ratios (RRs) and mean differences (MD) were pooled for dichotomous and continuous outcomes to estimate the network effects. Quality assessment was done using the Cochrane Risk of Bias (RoB) 2.0 tool.

Eighteen randomized controlled trials (RCTs) were included in this network meta-analysis. Rozanolixzumab (ROZ) 10 mg/kg significantly decreased the MG Activities of Daily Living (MG-ADL) score compared to placebo (MD= -2.33; 95%CI:[-3.60, -1.06]; p = 0.0003) and was ranked best (p-score = 0.77) regarding this outcome. Batoclimab (BAT) 680 mg significantly reduced the Quantitative MG (QMG) score compared to placebo (MD= -5.17; 95%CI:[-6.44, -3.89]; p <0.0001) and was rated the top performer (p-score = 0.96) for this endpoint. Regarding the MG Composite (MGC) score, BAT 340 mg was ranked best (p-score = 0.82). Eculizumab (ECU) was ranked best (p-score = 0.93) regarding the 15-item revised MG Quality of Life (MG-QoL 15r) score. Belimumab (BEL) 10 mg/kg was ranked best in terms of adverse events (p-score = 0.87).

ROZ 10 mg/kg ranked best for MG-ADL. BAT 680 mg significantly reduced QMG and ranked best. BAT 340 mg was best for MGC. ECU significantly decreased MG-QoL 15r and ranked best. BEL 10 mg/kg was ranked best regarding adverse events.