Comparison between Rituximab and Cyclophosphamide in Treatment of ANCA-Associated Vasculitis on Remission Induction: A Meta-Analysis

Abstract

Objectives: Currently, immunosuppressants including cyclophosphamide and azathioprine are the main treatment options for anti-neutrophil associated vasculitis. However, since cyclophosphamide may cause serious adverse reactions, it is necessary to explore for a new drug, and rituximab is one option with less adverse reaction. There are a few studies on rituximab versus cyclophosphamide in the treatment of antineutrophil associated vasculitis. The meta-analysis is carried out to evaluate the efficacy of rituximab, compared with cyclophosphamide, as a remission induction therapy in AAV. Methods: Firstly we searched a Chinese database (CNKI, Wanfang) and English databases (Pubmed, Cochrane Library, Embase) according to inclusion criteria and exclusion criteria before October, 2021. Then Revman5.4 and Stata were used for data analysis which was then integrated by fixed effects or random effects. Results: After browsing the full texts, we finally included 7 eligible articles, involving 737 patients in total. With Revman5.4 software, we could draw the following conclusions: 6-month complete response rate (Chi²=0.46, df=1 P=0.50 I²=0%), 12-month complete response rate (Chi²=0.31 df=1 P=0.58 I²=0%), 18-month complete response rate (Chi²=0.18 df=1 P=0.67 I²=0%). Adverse event (Chi²=3.15 df=4 P=0.53 I²=0%), respectively for reached primary endpoint, failed primary endpoint in contrast. The result showed (Chi²=3.29 df=3 P=0.35 I²=9%, Chi²=1.72 df=2 P=0.42 I²=0%), 6-momth relapse, 12-momth relapse, 18-month relapse (Chi²=0.22 df=1 P=0.64 I²=0%, Chi²=0.04 df=2 P=0.98 I²=0%, Chi²=0.13 df=1 P=0.72 I²=0%), GPA 0f 6-month (Chi²=0.47 df=1 P=0.50 I²=0%), MPA of 6-month (Chi²=1.52 df=1 P=0.22 I²=34%). The above data are statistically significant. Conclusion: Based on the above data, we can conclude that compared with cyclophosphamide, rituximab can play a certain role in the treatment of ANCA disease, improve the complete response rate, reduce the rate of adverse reactions and recurrence, and is expected to replace cyclophosphamide as a first-line drug in clinical practice.