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. 2019 Mar 11:13:845-856.
doi: 10.2147/DDDT.S195113. eCollection 2019.

Clinical efficacy and safety of rituximab in lupus nephritis

Zhiqing Zhong  1 , Hongyan Li  2 , Hongzhen Zhong  1 , Tianbiao Zhou  1
Affiliations

Clinical efficacy and safety of rituximab in lupus nephritis

Zhiqing Zhong et al. Drug Des Devel Ther. .

Abstract

Background: Long-term treatment programs with low toxicity represent a therapeutic challenge in lupus nephritis (LN). Although a therapeutic benefit of rituximab (RTX) has been reported in LN patients who have failed conventional treatment, the results are controversial. We aimed to assess the clinical efficacy and safety of RTX as a new immunosuppressive medicine in the treatment of LN with a meta-analysis.

Methods: Based on predetermined criteria, PubMed, Embase, and Cochrane Library were used to identify the eligible studies. Cochrane Review Manager version 5.3 was applied to pool the data extracted from individual investigations and provide summary effect estimates.

Results: Twenty-four studies with 940 patients were analyzed. In case series trials with specific LN assessment, the complete remission (CR) rate at 12 months was 35.9% (95% CI: 24.2%-49.5%), and total remission (TR: CR plus partial remission) was 73.4% (95% CI: 66.0%-79.7%). In controlled trials, RTX was associated with a higher probability of TR (OR =2.02, 95% CI: 1.23-3.32, P<0.01). The CR in the RTX group was higher than that in the control group, although there was no significant difference between the two groups (OR =1.98, 95% CI: 0.90-4.39, P>0.05). Additionally, RTX treatment significantly decreased proteinuria (mean difference: -2.79, 95% CI: -3.95 to -1.62, P<0.01) as well as the renal activity index in patients with LN (mean difference: -3.46, 95% CI: -4.43 to -2.50, P<0.01). In controlled trials, the relative risks of the adverse events of infection and infusion reaction were not notably different between the two groups.

Conclusion: RTX is a promising therapy for the treatment of LN due to significant clinical efficacy and a favorable safety profile. In future studies, larger study populations and longer-term time points may identify additional important patient-centered outcomes.

Keywords: efficacy; lupus nephritis; meta-analysis; rituximab; safety; systemic lupus erythematosus.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Results of the meta-analysis of remission in LN patients treated with rituximab in case series trials. Abbreviation: LN, lupus nephritis.
Figure 2
Figure 2
Results of the meta-analysis of remission in LN patients treated with rituximab in controlled trials. Abbreviations: LN, lupus nephritis; RTX, rituximab.
Figure 3
Figure 3
Results of meta-analysis of proteinuria in LN patients treated with rituximab. Abbreviation: LN, lupus nephritis.
Figure 4
Figure 4
Results of meta-analysis of activity renal index in LN patients treated with rituximab. Abbreviation: LN, lupus nephritis.
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