Effectiveness of Immunosuppressive Therapy in Preventing the Progression of Ocular Myasthenia Gravis to Generalized Myasthenia Gravis: A Systematic Review and Meta-Analysis

Ocular myasthenia gravis (OMG) is a localized form of myasthenia gravis (MG) that primarily affects the extraocular muscles, causing symptoms such as ptosis and diplopia. Without treatment, patients with OMG can progress to generalized MG (gMG), which involves systemic muscle weakness and can lead to severe complications. Immunosuppressive therapy aims to modulate the autoimmune response that underlies MG by reducing the production of pathogenic autoantibodies against the acetylcholine receptors (AChRs) or related neuromuscular junction components. This systematic review and meta-analysis evaluated the effectiveness of immunosuppressive therapy in preventing progression from OMG to gMG. A comprehensive literature search was conducted across PubMed, Web of Science, and Embase databases for studies published through January 2025. Ten retrospective observational studies met inclusion criteria, comprising 1,458 participants, with 761 receiving immunosuppression therapy. The meta-analysis revealed that immunosuppressive therapy significantly reduced the risk of generalization compared to control groups (OR: 0.23, 95%CI: 0.15-0.38, I2: 34%), representing a 77% decrease in progression rate. Sensitivity analyses demonstrated robust findings, with consistent ORs ranging from 0.21 to 0.27 after sequential removal of individual studies. The funnel plot showed no significant publication bias. However, the review was limited by the retrospective nature of included studies, moderate heterogeneity, and predominant focus on Western populations. These findings support the use of immunosuppressive therapy in preventing OMG progression, though further research through multicenter randomized controlled trials is needed to establish optimal treatment protocols, particularly in Asian populations. Future studies should also investigate biomarkers for treatment response and compare effectiveness between different immunosuppressive regimens.