Department of Respiration, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Department of Rheumatology, The Affiliated Hospital of Guilin Medical University, Guilin, China.
Int J Rheum Dis. 2019 Aug;22(8):1361-1370. doi: 10.1111/1756-185X.13596. Epub 2019 May 17.
The aim of this study was to assess the differences in infection rates between rituximab (RTX) and non-RTX treatment in patients with rheumatoid arthritis (RA).
A systematic review and meta-analysis was conducted by searching databases of PubMed, MEDLINE, EMBASE, Web of Science and Cochrane Library through to June 2018. We included studies that compared RTX and non-RTX treatment for patients with RA. Outcome measures were overall infections and serious infections between RTX and non-RTX treatments.
A total of 11 articles, including 9502 patients (4595 with RTX treatment and 4907 with non-RTX treatment) met our inclusion criteria. The results demonstrated that RTX-related all infections and serious infections in RA patients were 43.8% and 4.4%, respectively. Pooled analysis showed no significant differences between RTX and non-RTX treatment groups in overall infections rate (43.3% vs 44.9%; odds ratio [OR] = 0.87; 95% CI = 0.70-1.08) and serious infections rate (4.1% vs 4.6%; OR = 1.05; 95% CI = 0.84-1.31). Subgroup analysis also showed no significant differences in overall infections between RTX versus placebo (OR = 0.98, 95% CI = 0.71-1.33); RTX versus tumor necrosis factor inhibitors (TNFi) (OR = 0.47, 95% CI = 0.30-1.73); RTX plus methotrexate (MTX) versus placebo plus MTX (OR = 0.98, 95% CI = 0.77-1.24), and in serious infections between RTX versus placebo (OR = 1.06, 95% CI = 0.36-3.07); RTX versus TNFi (OR = 1.25, 95% CI = 0.96-1.63); RTX plus MTX versus placebo plus MTX (OR = 0.69, 95% CI = 0.39-1.20).
In patients with RA, RTX treatment has no additional risks for infections over non-RTX treatment.
本研究旨在评估类风湿关节炎（RA）患者接受利妥昔单抗（RTX）与非 RTX 治疗的感染率差异。
通过检索 PubMed、MEDLINE、EMBASE、Web of Science 和 Cochrane 图书馆数据库，对截至 2018 年 6 月的研究进行了系统评价和荟萃分析。我们纳入了比较 RTX 和非 RTX 治疗 RA 患者的研究。结局指标为 RTX 和非 RTX 治疗组的总体感染和严重感染。
共有 11 篇文章，包括 9502 名患者（4595 名接受 RTX 治疗，4907 名接受非 RTX 治疗）符合纳入标准。结果表明，RA 患者的 RTX 相关所有感染和严重感染分别为 43.8%和 4.4%。汇总分析显示，RTX 组与非 RTX 组的总体感染率（43.3%比 44.9%；比值比[OR] = 0.87；95%可信区间[CI] = 0.70-1.08）和严重感染率（4.1%比 4.6%；OR = 1.05；95% CI = 0.84-1.31）无显著差异。亚组分析也显示，RTX 与安慰剂（OR = 0.98，95% CI = 0.71-1.33）、RTX 与肿瘤坏死因子抑制剂（TNFi）（OR = 0.47，95% CI = 0.30-1.73）、RTX 加甲氨蝶呤（MTX）与安慰剂加 MTX（OR = 0.98，95% CI = 0.77-1.24）相比，总体感染无显著差异，RTX 与安慰剂（OR = 1.06，95% CI = 0.36-3.07）、RTX 与 TNFi（OR = 1.25，95% CI = 0.96-1.63）、RTX 加 MTX 与安慰剂加 MTX（OR = 0.69，95% CI = 0.39-1.20）相比，严重感染也无显著差异。
在 RA 患者中，RTX 治疗与非 RTX 治疗相比，感染风险无增加。
