Rituximab Therapy for Adult Refractory Systemic Lupus Erythematosus with Neurological and/or Psychiatric Presentations: A PRISMACompliant Meta-Analysis

IF 1.2 Q4 RHEUMATOLOGY

Current rheumatology reviews Pub Date : 2024-08-12 DOI:10.2174/0115733971309959240722062141

Mehran Asad Ayoubi, Maryam Moghaddassi, Mehdi Aloosh

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引用次数: 0

Abstract

Background: Rituximab (RTX) is used off-label for refractory cases of systemic lupus erythematosus (SLE) with extrarenal activity, including neurological and/or psychiatric (N/P) presentations. However, evidence from randomized controlled trials is limited.

Objective: This study aimed to conduct a pooled analysis of the effectiveness and safety of RTX therapy for adult refractory SLE with N/P manifestations.

Methods: Electronic searches in PubMed, Epistemonikos, and ICTRP databases and statistical analysis were conducted in May 2023.

Results: Electronic searches identified 20 studies (25 reports). A total of 59 patients (53 females; 90%) were included, with a mean age of 33.5±10.6 years and a median disease duration of 3.5 years (range, 0.08 to 25.0) who were followed up post-RTX therapy for a median time of 12 months (range, 3.0 to 46.2). The rate of clinical response (partial or major) was 90% (95% CI, 83 to 96) (n = 57 patients). A third of responders relapsed after a median time of 9.5 months (range, 3.0 to 33.0). Pooled pre-RTX/post-RTX scores for Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) (n = 13) were 19±15/7±5 and for neurological British Isles Lupus Assessment Group (BILAG) (n = 29) were A/D (13), A/C (5), B/D (7), B/C (2), and A/A (2). Patients without mood disorder had a higher chance of clinical response {relative risk (RR) 1.4 (1.03 to 1.48)}. Patients who benefited the most from RTX therapy were those with psychosis (a higher chance of major clinical response; RR 1.9 (1.02 to 2.34)), without acute confusional state (a lower chance of relapse; RR 0.08 (0.006 to 0.791)), and with disease duration <3 years (a lower chance of relapse; RR 0.18 (0.014 to 0.992)). Infection rate during treatment was 33% (7/21).

Conclusions: RTX therapy had good effectiveness. The pooled evidence for safety outcomes was limited and of low certainty.

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利妥昔单抗治疗伴有神经和/或精神症状的成人难治性系统性红斑狼疮：符合PRISMA标准的荟萃分析。

背景：利妥昔单抗（RTX利妥昔单抗（Rituximab，RTX）在标签外被用于治疗具有肾外活动的系统性红斑狼疮（SLE）难治性病例，包括神经和/或精神（N/P）症状。然而，来自随机对照试验的证据有限：本研究旨在对RTX治疗伴有N/P表现的成人难治性系统性红斑狼疮的有效性和安全性进行汇总分析：方法：对数据库进行电子检索，并进行统计分析：2023年5月，在PubMed、Epistemonikos和ICTRP中进行电子检索，共发现20项研究（25篇报告）。共纳入 59 名患者（53 名女性；90%），平均年龄为（33.5±10.6）岁，中位病程为 3.5 年（范围为 0.08 至 25.0），RTX 治疗后随访的中位时间为 12 个月（范围为 3.0 至 46.2）。临床应答率（部分或主要应答）为 90%（95% CI，83 至 96）（57 例患者）。三分之一的应答者在中位时间9.5个月（3.0至33.0个月）后复发。RTX前/RTX后系统性红斑狼疮疾病活动指数（SLEDAI）（n = 13）的汇总评分为19±15/7±5，神经系统的英伦三岛狼疮评估组（BILAG）（n = 29）评分为A/D（13）、A/C（5）、B/D（7）、B/C（2）和A/A（2）。没有情绪障碍的患者有更高的临床应答几率{相对风险（RR）1.4（1.03 至 1.48）}。从RTX治疗中获益最多的患者是那些患有精神病（出现重大临床反应的几率更高；RR为1.9（1.02至2.34））、没有急性意识混乱状态（复发几率较低；RR为0.08（0.006至0.791））以及病程结论为结论的患者：RTX疗法具有良好的疗效。有关安全性结果的汇总证据有限，且确定性较低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current rheumatology reviews RHEUMATOLOGY-

CiteScore

2.30

自引率

0.00%

发文量

期刊介绍： Current Rheumatology Reviews publishes frontier reviews on all the latest advances on rheumatology and its related areas e.g. pharmacology, pathogenesis, epidemiology, clinical care, and therapy. The journal"s aim is to publish the highest quality review articles dedicated to clinical research in the field. The journal is essential reading for all researchers and clinicians in rheumatology.