Rituximab Treatment in Adult Patients With Idiopathic Inflammatory Myositis: A Systematic Review and Meta-analysis.

IF 2.4 4区医学 Q2 RHEUMATOLOGY

JCR: Journal of Clinical Rheumatology Pub Date : 2025-01-01 Epub Date: 2024-11-11 DOI:10.1097/RHU.0000000000002151

Lilian Otalora Rojas, Karishma Ramsubeik, Luis Sanchez-Ramos, Shastri Motilal, Jasvinder A Singh, Gurjit S Kaeley

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引用次数: 0

Abstract

Objective: This systematic review and meta-analysis assess the efficacy and safety of rituximab (RTX) in treating idiopathic inflammatory myositis (IIM).

Methods: PubMed and Embase were systematically searched for trials and observational studies involving RTX use in IIM. Data were analyzed using a random-effects model to generate pooled estimates for overall response, complete remission, partial response, and adverse events, with subgroup analyses by myositis type and RTX dosage (PROSPERO registered number CRD42022353740). Risk of bias assessments were done using the Newcastle-Ottawa Scale for observational studies and risk of bias 1 tool for trials.

Results: Seventeen studies (1 randomized controlled trial and 16 observational studies), encompassing 362 patients, were included. The overall pooled response rate was 70% (95% confidence interval [CI]: 57%-82%; I2 = 74%, p < 0.001). Complete remission occurred in 13% (95% CI: 3%-25%; I2 = 79%, p < 0.001) and partial response in 48% (95% CI: 30%-67%; I2 = 87%, p < 0.001), both with significant heterogeneity. Subgroup analysis revealed high response rates across all myositis types: polymyositis 69%, dermatomyositis 67%, antisynthetase syndrome 70%, juvenile dermatomyositis 60%, and immune-mediated necrotizing myopathy 86%. Response rates were similar between RTX induction doses of 1 g IV on days 0 and 14 (68%) and 375 mg/m 2 weekly for 4 weeks (71%). Reported adverse events totaled 120, including infusion reactions (18.5%) and infections (12.4%).

Conclusions: RTX shows a favorable clinical response in IIM treatment, though response rates vary. There was a significant heterogeneity in treatment effect estimates that are based on a small number of patients. The incidence of infusion reactions and infections highlights the need for careful monitoring. Further controlled trials are essential to refine treatment protocols and evaluate long-term outcomes for RTX's role in IIM.

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利妥昔单抗治疗特发性炎症性肌炎成人患者：系统回顾与元分析》。

目的：本系统综述和荟萃分析评估了利妥昔单抗（RTX）治疗特发性炎性肌炎（IIM）的有效性和安全性：本系统综述和荟萃分析评估了利妥昔单抗（RTX）治疗特发性炎症性肌炎（IIM）的有效性和安全性：系统检索了PubMed和Embase中涉及RTX用于特发性炎症性肌炎的试验和观察性研究。采用随机效应模型对数据进行分析，得出总体反应、完全缓解、部分反应和不良事件的汇总估计值，并根据肌炎类型和RTX剂量进行亚组分析（PROSPERO注册号为CRD42022353740）。对观察性研究采用纽卡斯尔-渥太华量表进行偏倚风险评估，对试验采用偏倚风险1工具进行评估：共纳入 17 项研究（1 项随机对照试验和 16 项观察性研究），涉及 362 名患者。总体汇总反应率为 70%（95% 置信区间 [CI]：57%-82%；I2 = 74%，P < 0.001）。完全缓解发生率为 13%（95% 置信区间：3%-25%；I2 = 79%，p < 0.001），部分应答发生率为 48%（95% 置信区间：30%-67%；I2 = 87%，p < 0.001），两者均存在显著的异质性。亚组分析显示，所有肌炎类型的应答率都很高：多发性肌炎为69%，皮肌炎为67%，抗合成酶综合征为70%，幼年皮肌炎为60%，免疫介导的坏死性肌病为86%。RTX诱导剂量为第0天和第14天静脉注射1克（68%）和每周注射375毫克/平方米持续4周（71%），两者的应答率相似。报告的不良事件共计120起，包括输液反应（18.5%）和感染（12.4%）：结论：RTX在IIM治疗中显示出良好的临床反应，尽管反应率各不相同。结论：RTX 在 IIM 治疗中显示出良好的临床反应，尽管反应率各不相同，但基于少数患者的治疗效果估计值存在明显的异质性。输液反应和感染的发生率凸显了仔细监测的必要性。进一步的对照试验对于完善治疗方案和评估 RTX 在 IIM 中的长期疗效至关重要。

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

JCR: Journal of Clinical Rheumatology 医学-风湿病学

CiteScore

3.50

自引率

2.90%

发文量

228

审稿时长

4-8 weeks

期刊介绍： JCR: Journal of Clinical Rheumatology the peer-reviewed, bimonthly journal that rheumatologists asked for. Each issue contains practical information on patient care in a clinically oriented, easy-to-read format. Our commitment is to timely, relevant coverage of the topics and issues shaping current practice. We pack each issue with original articles, case reports, reviews, brief reports, expert commentary, letters to the editor, and more. This is where you''ll find the answers to tough patient management issues as well as the latest information about technological advances affecting your practice.