Effect of Rituximab Versus Mycophenolate Mofetil or Cyclophosphamide as Control in Lupus Nephritis: A Meta-Analysis

Abstract

Objective: To evaluate the effects of rituximab versus mycophenolate mofetil or cyclophosphamide as control in lupus nephritis by meta-analysis. Methods: A systematic search was carried out up to January 2022, obtaining 7 studies involving 645 participants with lupus nephritis at the commencement of the investigation; 198 of them were treated with rituximab, while 447 were treated with mycophenolate mofetil or cyclophosphamide. We determined the odds ratio (OR) and mean difference (MD) with 95% confidence index (CI) to compare rituximab’s efficacy to that of mycophenolate mofetil or cyclophosphamide as control in lupus nephritis using random- or fixed-effects model by dichotomous or continuous techniques. Results: The rituximab group showed significantly higher complete renal remission rate (OR = 2.52; 95% CI 1.30–4.91, P = 0.006) and total renal remission rates (OR = 2.22; 95% CI 1.36–3.63, P = 0.001) than the control group. However, there was no significant difference in terms of end Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score (MD -1.16; 95% CI -2.88–0.57, P = 0.19), proteinuria (MD -0.31; 95% CI -0.70–0.09, P = 0.013), and serum creatinine (MD 0.01; 95% CI -0.04–0.07, P = 0.64) between the rituximab group and the control. Conclusion: Rituximab exhibited significantly greater complete renal remission rate and total renal remission rates, with no significant difference in terms of shorter-end SLEDAI, proteinuria, and serum creatinine, compared with the control in individuals with lupus nephritis.