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OBJECTIVE To indirectly compare and evaluate the efficacy and safety of rituximab， tocilizumab， eculizumab， inebilizumab and satralizumab in preventing the relapse of neuromyelitis optica spectrum disorders， so as to provide reference for clinical drug use. METHODS Retrieved from Embase， Medline， PubMed， CNKI， ClinicalTrials. gov， UMIN Clinical Trials Registry and Chinese Clinical Trial Registry， randomized controlled trials （RCTs） about five monoclonal antibodies （trial group） versus placebo or other therapeutic scheme （control group） were collected during the inception to Apr. 2022. Two reviewers independently screened literature， extracted data， and assessed the quality of included literature with Cochrane risk bias assessment tool. OpenBUGS software was used for network meta-analysis. In terms of safety， Chi-square test was performed for adverse events （AEs） in trial group and control group. RESULTS A total of 7 RCTs were included， involving 793 patients. The results of surface under the cumulative ranking curve （SUCRA） showed the order of capabilities decreasing relapse risk was： eculizumab＞ rituximab＞inebilizumab＞satralizumab； the order of capabilities reducing the annual recurrence rate was： eculizumab＞ satralizumab； the order of capabilities improving the progress of disability was： eculizumab＞satralizumab＞inebilizumab＞ rituximab＞tocilizumab. In terms of safety， the results of χ2 test showed that there were no statistically significant differences in the risk of total AEs and serious AEs in each study between trial groups and control groups （P＞0.05）； the incidence of infusion reaction， nausea and vomiting in rituximab group， and that of upper respiratory tract infection in eculizumab group were significantly higher than placebo group （P＜0.05）. CONCLUSIONS The effect of eculizumab is more optimal in three outcomes； in terms of improving the progress of disability， eculizumab， satralizumab and inebilizumab are more effective than the other two drugs； in terms of safety， there are significant goldenmoonsp@163.com differences in some AEs with different grades and individual AEs， but it is not found that they are inconsistent with the 学。E-mail：liyingpds@126.com reported results of the existing literature and drug instructions.