Unit:
Postgraduate Programme Biostatistics & Health Science DataLibrary of the School of Health Sciences
Author:
Kostopoulou Myrto
Supervisors info:
Φώτιος Σιάννης, Επίκουρος Καθηγητής, Μαθηματικό, ΕΚΠΑ
Γεώργιος Μουστάκας, Διευθυντής, Γενικό Νοσοκομείο Αθηνών "Γεώργιος Γεννηματάς"
Νικόλαος Πανταζής, Ε.ΔΙ.Π, Ιατρική, ΕΚΠΑ
Original Title:
Εκτίμηση της αποτελεσματικότητας του rituximab ως θεραπεία επαγωγής στη νεφρίτιδα του συστηματικού ερυθηματώδη λύκου: συστηματική ανασκόπηση και μετα-ανάλυση
Translated title:
Efficacy of rituximab as induction therapy in lupus nephritis: systematic review and meta-analysis
Summary:
Introduction: Systemic Lupus Erythematosus (SLE) is a chronic inflammatory autoimmune disease that may affect many organs. Renal involvement is a common and typical feature of SLE that may alter prognosis. Despite the use of aggressive therapeutic protocols some patients fail to achieve remission, have frequent relapses or have adverse events related to therapy. Rituximab (RTX) is a chimeric monoclonal antibody that has been introduced in pilot studies to test its efficacy in patients with relapsing and resistant lupus nephritis (LN).
Objectives: The aim of the present study was to systematically review and meta-analyze the available data concerning the efficacy of RTX as induction therapy in patients with LN.
Methods: Electronic databases were searched to identify studies with prespecified inclusion/exclusion criteria. The measured effect size was the proportion of patients with LN achieving remission after the administration of RTX in 6, 12 and 24months. Meta-analysis was performed with random effects model. Univariate metaregression models for 3 different variables were used to check their possible impact on heterogeneity.
Results: Out of 333 reports, 19 studies were selected for the systematic review (17 observational studies with 294 patients and 2 randomized clinical trials) and 14 studies were included in meta-analysis. From the estimation of the pooled effect at different time points: 1) at 6-month follow-up 31% (20%-46%) of patients had complete remission and 29% (15%-47%) had partial remission 2) at 12-month follow-up 36% (20%-55%) of patients achieved complete remission while 32% (23%-44%) had partial and 3) at 24 months the proportion of patients with remission was 59% (47%-70%). Meta-regression models failed to show a statistically significant effect. Sub-group analysis in two time-points (6 months vs 12 months) showed a possible long-term effect of RTX.
Conclusion: RTX is an effective treatment as induction therapy in relapsing and resistant LN.
Main subject category:
Health Sciences
Keywords:
Rituximab, Nephritis, Systemic lupus erythematosus, Induction therapy
