利妥昔单抗治疗系统性硬化症相关间质性肺疾病：系统评价和荟萃分析。

Rituximab in the treatment of systemic sclerosis-related interstitial lung disease: a systematic review and meta-analysis.

机构信息

Department of Rheumatology, All India Institute of Medical Sciences, New Delhi, India.

Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.

出版信息

Rheumatology (Oxford). 2021 Feb 1;60(2):557-567. doi: 10.1093/rheumatology/keaa550.

DOI:10.1093/rheumatology/keaa550

PMID:33164098

Abstract

OBJECTIVES

To assess the effect of rituximab (RTX) on the lung function parameters in SSc interstitial lung disease (SSc-ILD) patients.

METHODS

PubMed and Embase were searched to identify studies on SSc-ILD treated with RTX, confined to a predefined inclusion and exclusion criteria. A systematic review and meta-analysis were performed on the included studies on changes in forced vital capacity (FVC) and diffusion capacity of carbon monoxide (DLCO) from baseline to 6 and 12 months of follow-up.

RESULTS

A total of 20 studies (2 randomized controlled trials, 6 prospective studies, 5 retrospective studies and 7 conference abstracts) were included (n = 575). RTX improved FVC from baseline by 4.49% (95% CI 0.25, 8.73) at 6 months and by 7.03% (95% CI 4.37, 9.7) at 12 months. Similarly, RTX improved DLCO by 3.47% (95% CI 0.99, 5.96) at 6 months and 4.08% (95% CI 1.51, 6.65) at 12 months. In the two studies comparing RTX with other immunosuppressants, improvement of FVC by 6 months in the RTX group was 1.03% (95% CI 0.11, 1.94) greater than controls. At the 12 month follow-up, RTX treatment was similar to controls in terms of both FVC and DLCO. Patients treated with RTX had a lower chance of developing infections compared with controls [odds ratio 0.256 (95% CI 0.104, 0.626), I2 = 0%, P = 0.47).

CONCLUSIONS

Treatment with RTX in SSc-ILD was associated with a significant improvement of both FVC and DLCO during the first year of treatment. RTX use was associated with lower infectious adverse events.

摘要

目的

评估利妥昔单抗（RTX）对系统性硬化症间质性肺病（SSc-ILD）患者肺功能参数的影响。

方法

在 PubMed 和 Embase 上检索了专门针对 SSc-ILD 患者接受 RTX 治疗的研究，并限定了明确的纳入和排除标准。对纳入的研究进行了系统评价和荟萃分析，以评估从基线到 6 个月和 12 个月随访时用力肺活量（FVC）和一氧化碳弥散量（DLCO）的变化。

结果

共纳入 20 项研究（2 项随机对照试验、6 项前瞻性研究、5 项回顾性研究和 7 项会议摘要）（n=575）。RTX 在 6 个月时使 FVC 从基线增加了 4.49%（95%CI 0.25，8.73），在 12 个月时增加了 7.03%（95%CI 4.37，9.7）。同样，RTX 在 6 个月时使 DLCO 增加了 3.47%（95%CI 0.99，5.96），在 12 个月时增加了 4.08%（95%CI 1.51，6.65）。在两项将 RTX 与其他免疫抑制剂进行比较的研究中，RTX 组在 6 个月时 FVC 的改善比对照组高 1.03%（95%CI 0.11，1.94）。在 12 个月的随访中，RTX 治疗在 FVC 和 DLCO 方面与对照组相似。与对照组相比，接受 RTX 治疗的患者发生感染的机会较低[比值比 0.256（95%CI 0.104，0.626），I2=0%，P=0.47]。