利妥昔单抗治疗肉芽肿伴多血管炎难治性器官受累的疗效：病例报告的系统评价。
Efficacy of Rituximab on Refractory Organ Involvements in Granulomatosis with Polyangiitis: A Systematic Review of Case Reports.
机构信息
Student Research Committee, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran.
Student Research Committee, Medical School, Alborz University of Medical Sciences, Karaj, Iran.
出版信息
Curr Rheumatol Rev. 2024;20(3):270-283. doi: 10.2174/0115733971263964231020072640.
INTRODUCTION
Granulomatosis with polyangiitis (GPA) is a type of Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) characterized by necrotizing vasculitis affecting small and medium-sized blood vessels. GPA affects various organs, with respiratory tract, vasculitis and glomerulonephritis being the most common triad. Remission induction and maintenance therapy for GPA traditionally involves corticosteroids and cyclophosphamide. However, treatment with rituximab, a monoclonal antibody that depletes B-cells involved in autoimmune disease, has been successful in inducing remission in several studies. The purpose of this systematic review was to investigate the efficacy of rituximab in treating various clinical manifestations of GPA.
METHODS
In adherence to PRISMA guidelines for systematic reviews and meta-analyses, we carried out a comprehensive review to investigate the effectiveness of rituximab on particular organ involvement in GPA. We searched three databases (PubMed, Scopus, and Embase) up until November 6, 2022, for case reports on the topic. To ensure all relevant studies were included, we manually screened the first 50 pages of Google Scholar's search results.
RESULTS
The review identified a total of 64 case reports and a case series of 113 cases, highlighting the effectiveness of rituximab in treating refractory organ involvement in GPA. The review also analyzed the effectiveness of rituximab in treating ocular, CNS, cardiac, pulmonary, cutaneous, gastrointestinal, renal, and other organ involvements in GPA.
CONCLUSIONS
Our results indicated that rituximab can be a promising therapy for treating specific clinical manifestations of several organ involvements. However, more research is needed to determine the long-term efficacy of rituximab in treating GPA.
介绍
肉芽肿性多血管炎（GPA）是一种抗中性粒细胞胞质抗体（ANCA）相关性血管炎（AAV），其特征为影响小及中等血管的坏死性血管炎。GPA 影响多种器官，呼吸道、血管炎和肾小球肾炎是最常见的三联征。GPA 的缓解诱导和维持治疗传统上涉及皮质类固醇和环磷酰胺。然而，利妥昔单抗（一种消耗与自身免疫性疾病相关的 B 细胞的单克隆抗体）的治疗在几项研究中已成功诱导缓解。本系统评价的目的是研究利妥昔单抗治疗 GPA 各种临床表现的疗效。
方法
根据 PRISMA 指南对系统评价和荟萃分析，我们进行了全面的综述，以研究利妥昔单抗对 GPA 特定器官受累的疗效。我们在 2022 年 11 月 6 日之前，在三个数据库（PubMed、Scopus 和 Embase）中搜索了关于该主题的病例报告。为确保纳入所有相关研究，我们手动筛选了 Google Scholar 搜索结果的前 50 页。
结果
综述共确定了 64 例病例报告和 113 例病例系列，强调了利妥昔单抗治疗 GPA 难治性器官受累的有效性。综述还分析了利妥昔单抗治疗 GPA 的眼部、中枢神经系统、心脏、肺部、皮肤、胃肠道、肾脏和其他器官受累的疗效。
结论
我们的结果表明，利妥昔单抗可能是治疗几种器官受累的特定临床表现的有前途的治疗方法。然而，需要更多的研究来确定利妥昔单抗治疗 GPA 的长期疗效。
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