Rituximab for the treatment of connective tissue disease–associated interstitial lung disease: A systematic review and meta-analysis
Background: Interstitial lung disease (ILD) is a common pulmonary disease often associated with significant morbidity and mortality in patients with connective tissue diseases (CTD). Currently, no gold-standard therapies are available for CTD-ILD. Recently, several studies have proposed that rituxim...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-10-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2022.1019915/full |
| _version_ | 1811335913670705152 |
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| author | Linrui Xu Linrui Xu Linrui Xu Faping Wang Faping Wang Faping Wang Fengming Luo Fengming Luo Fengming Luo |
| author_facet | Linrui Xu Linrui Xu Linrui Xu Faping Wang Faping Wang Faping Wang Fengming Luo Fengming Luo Fengming Luo |
| author_sort | Linrui Xu |
| collection | DOAJ |
| description | Background: Interstitial lung disease (ILD) is a common pulmonary disease often associated with significant morbidity and mortality in patients with connective tissue diseases (CTD). Currently, no gold-standard therapies are available for CTD-ILD. Recently, several studies have proposed that rituximab (RTX) may be effective for the treatment of CTD-ILD.Objectives: This study aimed to systematically evaluate the efficacy and safety of RTX for the treatment of CTD-ILD.Methods: Studies were selected from PubMed, Embase, and Cochrane Library, up to 20 July 2022. Improvement and stable rates were extracted as the main outcomes and pooled using the weighted mean proportion with fixed or random-effects models, in case of significant heterogeneity (I2 > 50%). Safety analysis was performed based on the adverse events reported in all of the studies.Results: Thirteen studies (312 patients) were included in the meta-analysis. The follow-up durations ranged from 6 to 36 months. The pooled improvement rate was 35.0% (95% CI: 0.277–0.442), while the pooled stable rate was 59.2% (95% CI: 0.534–0.656). Anti-synthetase syndrome associated with ILD [ASS-ILD, 48.1% (95% CI, 0.373–0.620)] and idiopathic inflammatory myopathies associated with ILD [IIM-ILD, non-ASS, 47.4% (95% CI, 0.266–0.846)] had higher improvement rates than the other types. A total of 106 adverse events associated with RTX or progressive ILD were reported among the 318 patients, 55.7% of which were mild. Among 19 deaths, 17 were due to ILD progression, one to severe pulmonary arterial hypertension, and one to Pneumocystis jirovecii infection.Conclusion: RTX, which exhibits a satisfactory safety profile, is an effective treatment option for CTD-ILD, even in patients who fail to respond to other therapies. Further randomized trials are needed to assess the efficacy of rituximab compared to other treatments for CTD-ILD.Systematic review registration: PROSPERO, identifier (CRD42022363403). |
| first_indexed | 2024-04-13T17:31:40Z |
| format | Article |
| id | doaj.art-a307e04604474d348f19586ff613892d |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-04-13T17:31:40Z |
| publishDate | 2022-10-01 |
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| series | Frontiers in Pharmacology |
| spelling | doaj.art-a307e04604474d348f19586ff613892d2022-12-22T02:37:33ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122022-10-011310.3389/fphar.2022.10199151019915Rituximab for the treatment of connective tissue disease–associated interstitial lung disease: A systematic review and meta-analysisLinrui Xu0Linrui Xu1Linrui Xu2Faping Wang3Faping Wang4Faping Wang5Fengming Luo6Fengming Luo7Fengming Luo8Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaLaboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaClinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaLaboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaClinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaLaboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaClinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaBackground: Interstitial lung disease (ILD) is a common pulmonary disease often associated with significant morbidity and mortality in patients with connective tissue diseases (CTD). Currently, no gold-standard therapies are available for CTD-ILD. Recently, several studies have proposed that rituximab (RTX) may be effective for the treatment of CTD-ILD.Objectives: This study aimed to systematically evaluate the efficacy and safety of RTX for the treatment of CTD-ILD.Methods: Studies were selected from PubMed, Embase, and Cochrane Library, up to 20 July 2022. Improvement and stable rates were extracted as the main outcomes and pooled using the weighted mean proportion with fixed or random-effects models, in case of significant heterogeneity (I2 > 50%). Safety analysis was performed based on the adverse events reported in all of the studies.Results: Thirteen studies (312 patients) were included in the meta-analysis. The follow-up durations ranged from 6 to 36 months. The pooled improvement rate was 35.0% (95% CI: 0.277–0.442), while the pooled stable rate was 59.2% (95% CI: 0.534–0.656). Anti-synthetase syndrome associated with ILD [ASS-ILD, 48.1% (95% CI, 0.373–0.620)] and idiopathic inflammatory myopathies associated with ILD [IIM-ILD, non-ASS, 47.4% (95% CI, 0.266–0.846)] had higher improvement rates than the other types. A total of 106 adverse events associated with RTX or progressive ILD were reported among the 318 patients, 55.7% of which were mild. Among 19 deaths, 17 were due to ILD progression, one to severe pulmonary arterial hypertension, and one to Pneumocystis jirovecii infection.Conclusion: RTX, which exhibits a satisfactory safety profile, is an effective treatment option for CTD-ILD, even in patients who fail to respond to other therapies. Further randomized trials are needed to assess the efficacy of rituximab compared to other treatments for CTD-ILD.Systematic review registration: PROSPERO, identifier (CRD42022363403).https://www.frontiersin.org/articles/10.3389/fphar.2022.1019915/fullconnective tissue disease-associated interstitial lung diseaserituximabefficacysafetymeta-analysis |
| spellingShingle | Linrui Xu Linrui Xu Linrui Xu Faping Wang Faping Wang Faping Wang Fengming Luo Fengming Luo Fengming Luo Rituximab for the treatment of connective tissue disease–associated interstitial lung disease: A systematic review and meta-analysis Frontiers in Pharmacology connective tissue disease-associated interstitial lung disease rituximab efficacy safety meta-analysis |
| title | Rituximab for the treatment of connective tissue disease–associated interstitial lung disease: A systematic review and meta-analysis |
| title_full | Rituximab for the treatment of connective tissue disease–associated interstitial lung disease: A systematic review and meta-analysis |
| title_fullStr | Rituximab for the treatment of connective tissue disease–associated interstitial lung disease: A systematic review and meta-analysis |
| title_full_unstemmed | Rituximab for the treatment of connective tissue disease–associated interstitial lung disease: A systematic review and meta-analysis |
| title_short | Rituximab for the treatment of connective tissue disease–associated interstitial lung disease: A systematic review and meta-analysis |
| title_sort | rituximab for the treatment of connective tissue disease associated interstitial lung disease a systematic review and meta analysis |
| topic | connective tissue disease-associated interstitial lung disease rituximab efficacy safety meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2022.1019915/full |
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