Fatma Alshaiki1, Elaf Obaid2, Abdulqader Almuallim2, Rabab Taha3, Hadeel El-Haddad3, Hani Almoallim2,3,4. 1. Department of Medicine, East Jeddah Hospital, Jeddah, Saudi Arabia. 2. Department of Medicine, Umm Al-Qura University School of Medicine, Makkah, Saudi Arabia. 3. Department of Medicine, Dr. Sloiman Fakeeh Hospital, Jeddah, Saudi Arabia. 4. Alzaidi Chair of Research in Rheumatic Diseases, Umm Al-Qura University, Makkah, Saudi Arabia.
Abstract
OBJECTIVE: Conventional treatment of systemic lupus erythematosus (SLE) and lupus nephritis (LN) is associated with damage accrual, hence increased morbidity rate. Off-label use of rituximab (RTX) has shown significant promise in this patient group; however, data are still controversial. We aimed to analyze the outcomes of RTX therapy in refractory lupus using a meta-analysis approach. METHODS: Electronic search of the medical literature was conducted using a combination of relevant keywords to retrieve studies on the safety and efficacy of RTX in SLE and LN patients. Results were screened against our inclusion and exclusion criteria and two reviewers independently extracted the data for analysis. Comprehensive meta-analysis software was used to pool the data from individual studies and provide summary effect estimates. RESULTS: Thirty-one studies that enrolled 1112 patients were finally eligible for the meta-analysis. The overall global, complete, and partial response rates to RTX therapy were 72%, 46%, and 32%, respectively. RTX significantly decreased Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and British Isles Lupus Activity Group (BILAG) scores (p<0.001). Prednisone dose was significantly reduced after RTX treatment in both SLE and LN groups (p<0.001), and proteinuria was lowered in SLE (p<0.001) than in LN patients (p=0.07). Infection and infusion-related reactions were the most common side effects. CONCLUSION: RTX therapy in refractory SLE and LN patients proved clinical efficacy and favorable safety outcomes. Larger well-designed randomized clinical trials are warranted.
OBJECTIVE: Conventional treatment of systemic lupus erythematosus (SLE) and lupus nephritis (LN) is associated with damage accrual, hence increased morbidity rate. Off-label use of rituximab (RTX) has shown significant promise in this patient group; however, data are still controversial. We aimed to analyze the outcomes of RTX therapy in refractory lupus using a meta-analysis approach. METHODS: Electronic search of the medical literature was conducted using a combination of relevant keywords to retrieve studies on the safety and efficacy of RTX in SLE and LN patients. Results were screened against our inclusion and exclusion criteria and two reviewers independently extracted the data for analysis. Comprehensive meta-analysis software was used to pool the data from individual studies and provide summary effect estimates. RESULTS: Thirty-one studies that enrolled 1112 patients were finally eligible for the meta-analysis. The overall global, complete, and partial response rates to RTX therapy were 72%, 46%, and 32%, respectively. RTX significantly decreased Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and British Isles Lupus Activity Group (BILAG) scores (p<0.001). Prednisone dose was significantly reduced after RTX treatment in both SLE and LN groups (p<0.001), and proteinuria was lowered in SLE (p<0.001) than in LN patients (p=0.07). Infection and infusion-related reactions were the most common side effects. CONCLUSION:RTX therapy in refractory SLE and LN patients proved clinical efficacy and favorable safety outcomes. Larger well-designed randomized clinical trials are warranted.
Authors: Bevra H Hahn; Maureen A McMahon; Alan Wilkinson; W Dean Wallace; David I Daikh; John D Fitzgerald; George A Karpouzas; Joan T Merrill; Daniel J Wallace; Jinoos Yazdany; Rosalind Ramsey-Goldman; Karandeep Singh; Mazdak Khalighi; Soo-In Choi; Maneesh Gogia; Suzanne Kafaja; Mohammad Kamgar; Christine Lau; William J Martin; Sefali Parikh; Justin Peng; Anjay Rastogi; Weiling Chen; Jennifer M Grossman Journal: Arthritis Care Res (Hoboken) Date: 2012-06 Impact factor: 4.794
Authors: M Witt; M Grunke; F Proft; M Baeuerle; M Aringer; G Burmester; G Chehab; C Fiehn; R Fischer-Betz; M Fleck; K Freivogel; M Haubitz; I Kötter; S Lovric; C Metzler; A Rubberth-Roth; A Schwarting; C Specker; H-P Tony; L Unger; S Wassenberg; T Dörner; H Schulze-Koops Journal: Lupus Date: 2013-10 Impact factor: 2.911
Authors: Fausta Catapano; Afzal N Chaudhry; Rachel B Jones; Kenneth G C Smith; David W Jayne Journal: Nephrol Dial Transplant Date: 2010-05-11 Impact factor: 5.992
Authors: Maria E Tsanyan; Sergey K Soloviev; Stefka G Radenska-Lopovok; Anna V Torgashina; Ekaterina V Nikolaeva; Yaroslav B Khrennikov; Evgeniy L Nasonov Journal: Folia Med (Plovdiv) Date: 2014 Oct-Dec
Authors: Edward M Vital; Shouvik Dass; Maya H Buch; Karen Henshaw; Colin T Pease; Michael F Martin; Frederique Ponchel; Andrew C Rawstron; Paul Emery Journal: Arthritis Rheum Date: 2011-10