Abstract
BackgroundThe efficacy and safety of rituximab (RTX) on hemolytic anemia (HA) is unknown. Therefore we retrospectively analyze the efficacy and safety of RTX in autoimmune hemolytic anemia (AIHA) and microangiopathic hemolytic anemia (MAHA) from the previous literature.MethodsData in clinical trials and observational studies were collected from PubMed, Cochrane, Embase, and Google Scholar until Oct 15, 2018. The efficacy and safety of RTX in patients with AIHA or MAHA were assessed and overall response rates (ORRs), complete response rates (CRRs), adverse events (AEs) and relapse rates (RRs) were extracted if available. A meta-analysis was performed with a random-effects model, estimating mean proportions in all studies, and relative rates in comparative studies.ResultsAfter quality assessment, a total of 37 investigations encompassing 1057 patients eligible for meta-analysis were included. Pooled mean proportion of ORR was 0.84 (95% confidence interval [CI] 0.80–0.88), and that of CRR was 0.61 (95% CI 0.49–0.73). Mean AE rate was 0.14 (95% CI 0.10–0.17), and mean RR was 0.21 (95% CI 0.15–0.26). Relative ORR was 1.18 (95% CI 1.02–1.36), and relative CRR was 1.17 (95% CI 0.98–1.39) fold more than the respective non-RTX counter parts. Relative AE rate was 0.77 (95% CI 0.36–1.63), and relative RR was 0.93 (95% CI 0.56–1.55) fold less than the respective non-RTX counter parts.ConclusionRTX is more effective than the treatments without RTX for AIHA and MAHA and is well-tolerated.
Highlights
Hemolytic anemia (HA) is an anemia due to premature destruction of erythrocytes in the circulation before their normal demise [1]
Data synthesis and analysis Efficacy was assessed by overall response rate (ORR) and complete response rate (CRR)
Weighted mean proportions of response rate were calculated over all studies that included in the quantitative analysis, and relative ORR and relative CRR were calculated over comparative studies
Summary
Hemolytic anemia (HA) is an anemia due to premature destruction of erythrocytes (or red blood cells, RBCs) in the circulation before their normal demise [1]. AIHA is caused by autoantibodies against selfantigens in erythrocytes, leading to a premature RBC destruction, which could be diagnosed by a positive direct antiglobulin test (DAT) [3]. AIHA can be subdivided into warm, mixed, or cold-reactive subtypes, according to the optimal autoantibody-RBC reactivity. The prominent causes of MAHA are thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) [8]. The efficacy and safety of rituximab (RTX) on hemolytic anemia (HA) is unknown. We ret‐ rospectively analyze the efficacy and safety of RTX in autoimmune hemolytic anemia (AIHA) and microangiopathic hemolytic anemia (MAHA) from the previous literature
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