Rituximab therapy for lupus nephritis: A meta‑analysis

Abstract

The aim of the present study was to assess the clinical efficacy and safety of rituximab (RTX) therapy in the treatment of lupus nephritis by performing a meta‑analysis. For this purpose, the PubMed, Embase, Cochrane Library, Chinese Biomedical Literature, China National Knowledge Infrastructure, VIP Information and WANFANG databases were used to identify the eligible studies from January, 2000 to February, 2020. STATA16.0 and Review Manager Version 5.3 software were applied to pool the data. From the results of this search, 37 studies (30 case series and seven controlled trials) involving 1,273 patients were included. In the case series studies, the total remission (TR) rate was 81.9% (95% CI, 73.7‑88.8%) and the complete remission (CR) rate was 46.6% (95% CI, 36.4‑57.1%). Following treatment with RTX, the systemic lupus erythematosus disease activity index (SLEDAI) of patients with lupus nephritis decreased significantly [mean difference (MD), ‑8.91; 95% CI, ‑14.10 to ‑3.72, P<0.01]. The level of proteinuria also decreased significantly [standardized mean difference (SMD), ‑1.05; 95% CI, ‑1.28 to ‑0.83, P<0.01]. On the contrary, the level of serum albumin increased significantly (MD, 6.44; 95% CI, 4.42‑8.45; P<0.01). In the controlled trials, both TR and CR were significantly higher than those of the control group (TR: OR, 2.48; 95% CI, 1.58‑3.89; P<0.01; and CR: OR, 2.29; 95% CI, 1.17‑4.49; P<0.05). Compared with the control group, the SLEDAI of patients in the RTX group decreased significantly (MD, ‑3.84; 95% CI, ‑5.99 to ‑1.69; P<0.01) and the level of proteinuria in the RTX group also decreased significantly (MD, ‑1.24; 95% CI, ‑2.39 to ‑0.09; P<0.05). At the same time, the level of serum albumin increased (MD, 0.54; 95% CI, 0.22‑0.86; P<0.01). There was no difference in the relative risks of the adverse events between the two groups (OR, 0.37; P>0.05). On the whole, the findings of the present study demonstrate that RTX exhibits favorable clinical efficacy in the treatment of lupus nephritis, which can significantly reduce the level of proteinuria and SLEDAI, and increase the level of serum albumin. Compared with traditional immunosuppressive therapy (corticosteroids + cyclophosphamide and/or mycophenolate), RTX was more effective in the treatment of lupus nephritis. Additionally, rituximab exhibited good safety.