Efficacy of rituximab versus cyclophosphamide in connective tissue disease‑related interstitial lung disease: a systematic review and meta-analysis.

IF 2.9 3区医学 Q2 RHEUMATOLOGY

Clinical Rheumatology Pub Date : 2025-06-13 DOI:10.1007/s10067-025-07533-6

Yan Liu, Yaoxiu Liu, Junlai Xu, Guoxing Zeng, Qingyuan Yang, Shuiming Xu

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引用次数: 0

Abstract

Objective: This study systematically compares the efficacy and adverse events of rituximab (RTX) and cyclophosphamide (CYC) in patients with connective tissue disease-related interstitial lung disease (CTD-ILD).

Methods: The EMBASE, Cochrane, and PubMed databases were systematically searched to find all relevant studies. Quality assessment, study selection, and data extraction were independently conducted by two reviewers. The mean changes in percentage of predicted forced vital capacity (FVC%) and percentage of predicted diffusing capacity for carbon monoxide (DLco%) of the patients were selected to be primary outcome measures. RevMan 5 software was used for the pooled analysis.

Results: Among 1106 titles screened from multiple databases, six studies met the inclusion criteria (two randomized controlled trials and four retrospective observational studies). Patients of four studies were systemic sclerosis-related interstitial disease(SSc-ILD), one study was anti-synthetase syndrome-related interstitial lung disease (AsyS-ILD), and one study was CTD-ILD (included idiopathic inflammatory myositis (IIM), systemic sclerosis (SSc) or mixed connective tissue disease (MCTD), rheumatoid arthritis(RA)). The summary weight mean difference of FVC% change in the RTX group compared with the CYC group was 0.86 (95% CI:-1.51,3.24; P = 0.48), and the summary weight mean difference of DLco% change in the RTX group compared with the CYC group was 6.43 (95% CI: 1.62, 11.23; P = 0.009). Our pooled analysis suggested no significant difference in FVC% improvement between RTX and CYC. RTX seems to be slightly superior to CYC in terms of DLco% improvement in our meta-analysis. However, only three out of six enrolled studies provided data on DLco% change. Therefore, the results for DLco% change should be cautiously interpreted. Studies enrolled showed that adverse events were fewer in the RTX group. RTX appears to offer a favorable balance between efficacy and safety.

Conclusions: RTX demonstrated similar efficacy to CYC in improving lung function (FVC% and DLco%), with fewer adverse events.

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利妥昔单抗与环磷酰胺治疗结缔组织病相关间质性肺病的疗效：一项系统综述和荟萃分析

目的：系统比较利妥昔单抗（RTX）和环磷酰胺（CYC）治疗结缔组织病相关间质性肺疾病（CTD-ILD）的疗效和不良事件。方法：系统检索EMBASE、Cochrane和PubMed数据库，查找所有相关研究。质量评估、研究选择和数据提取由两名审稿人独立进行。预测强迫肺活量百分比（FVC%）和预测一氧化碳弥散量百分比（DLco%）的平均变化作为主要结局指标。采用RevMan 5软件进行汇总分析。结果：从多个数据库筛选的1106篇文献中，有6篇研究符合纳入标准（2项随机对照试验和4项回顾性观察性研究）。4项研究的患者为系统性硬化症相关间质性疾病（SSc- ild）， 1项研究为抗合成酶综合征相关间质性肺疾病（AsyS-ILD）， 1项研究为CTD-ILD（包括特发性炎症性肌炎（IIM）、系统性硬化症（SSc）或混合性结缔组织病（MCTD）、类风湿性关节炎（RA））。与CYC组相比，RTX组FVC%变化的总权重平均差为0.86 (95% CI:-1.51,3.24；P = 0.48)， RTX组与CYC组DLco%变化的总权重平均差为6.43 (95% CI: 1.62, 11.23；P = 0.009)。我们的综合分析显示，RTX和CYC之间的FVC%改善无显著差异。在我们的荟萃分析中，RTX在DLco%的改善方面似乎略优于CYC。然而，6项纳入的研究中只有3项提供了DLco%变化的数据。因此，DLco%变化的结果应谨慎解释。纳入的研究表明，RTX组的不良事件较少。RTX似乎在疗效和安全性之间提供了有利的平衡。结论：RTX改善肺功能（FVC%和DLco%）的效果与CYC相似，不良事件较少。

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

Clinical Rheumatology 医学-风湿病学

CiteScore

6.90

自引率

2.90%

发文量

441

审稿时长

3 months

期刊介绍： Clinical Rheumatology is an international English-language journal devoted to publishing original clinical investigation and research in the general field of rheumatology with accent on clinical aspects at postgraduate level. The journal succeeds Acta Rheumatologica Belgica, originally founded in 1945 as the official journal of the Belgian Rheumatology Society. Clinical Rheumatology aims to cover all modern trends in clinical and experimental research as well as the management and evaluation of diagnostic and treatment procedures connected with the inflammatory, immunologic, metabolic, genetic and degenerative soft and hard connective tissue diseases.