Comparison of Efficacy and Safety of Different Medication Protocols in Patients with Immunoglobulin G4–Related Disease Based on Follow-up Time: A Systematic Review and Network Meta-analysis

Background/Aims: Glucocorticoids (GCs) and disease-modifying antirheumatic drugs (DMARDs) are commonly used drugs in the treatment of immunoglobulin G4–related disease (IgG4-RD). However, no broad consensus is available on their intervention effects. Therefore, the efficacy and safety of different medication protocols in the treatment of IgG4-RD were assessed in this systematic review and network meta-analysis.

Materials and Methods: This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. RStudio and Stata 15.1 were used for data analysis.

Results: The results showed that in terms of improvement of remission rates, GCs + DMARDs had the strongest overall efficacy [surface under the cumulative ranking curve (SUCRA) = 82.9%], and DMARDs were the most effective within 12 months during follow-up (SUCRA = 82.5%), while GCs + DMARDs were the most effective over 12 months during follow-up (SUCRA = 83.2%). In terms of reduction of relapse rates, the overall efficacy of GCs + DMARDs was the strongest (SUCRA = 83.5%), and GCs + DMARDs performed the best both within and over 12 months during follow-up. The adverse reaction rates were 38.9%, 5.3%, and 33.3%, respectively, among patients treated with GCs + DMARDs, DMARDs, and GCs.

Conclusion: The GCs + DMARDs are recommended for short-term improvement of remission rates and reduction of relapse rates, as well as for achieving long-term efficacy.

Cite this article as: Liu Y, Fu X, Zhang Y, et al. Comparison of efficacy and safety of different medication protocols in patients with immunoglobulin G4–related disease based on follow-up time: A systematic review and network meta-analysis. ArchRheumatol. 2026;41(1):3-13.