Marina Maria Vieira de Figueiredo Caldas1, Kesley Pablo Morais de Azevedo2, Ana Clara de França Nunes3, Victor Hugo de Oliveira3, Isac Davidson Santiago Fernandes Pimenta3, Isabela Dantas Torres de Araújo4, Francisco Alves Bezerra Neto5, Ana Katherine da Silveira Gonçalves de Oliveira6, Grasiela Piuvezam3,7. 1. Medicine Student, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. 2. Post-Graduation Program in Public Health (PPGSCol), Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. kesley@ufrn.edu.br. 3. Post-Graduation Program in Public Health (PPGSCol), Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. 4. Post-Graduation Program in Dental Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. 5. Department of Clinical Medicine, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. 6. Department of Tocoginecology, Post-Graduation Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. 7. Department of Public Health, Post-Graduation Program in Public Health (PPGSCol), Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
Abstract
BACKGROUND: Systemic sclerosis (SSc) is a clinically complex and challenging disease, that leads to skin fibrosis. Its most frequent complication is interstitial lung disease (ILD), which leads to a worse prognosis. In this situation, cyclophosphamide is considered the gold standard for its treatment, despite the controversies regarding its efficacy and toxicity. However, studies using rituximab (RTX) have shown that this drug may be a promising therapeutic option. OBJECTIVES: This paper objective was to analyze the scientific evidence on the RTX effects on SSc. METHODS: A systematic review (SR) was performed including clinical trials (CTs) on the use of RTX in SSc, published up to May 2020. The studies were identified through systematic searches in bibliographic databases using a predefined search strategy. The following databases were used: PUBMED, SCOPUS, SCIELO, LILACS, SCIENCE DIRECT, WEB OF SCIENCE, COCHRANE, WHOLIS, PAHO and EMBASE. Also, a manual search was performed. The methodological quality of the studies was determined using Jadad scale, Risk of Bias Tool (RoB 2.0) and Risk of Bias in Non-Randomized Studies - of Interventions tool (ROBINS-I). A meta-analysis of the randomized CTs was performed, using Review Manager. RESULTS: Ten CTs were included in this SR. Of these, three were randomized and seven were non-randomized. Five showed a statistically significant improvement in forced vital capacity (FVC) at some time during follow-up. Regarding the skin, eight studies showed statistically significant improvements according toa the modified Rodnan skin score. The meta-analysis found positive effects of RTX in SSc, with a statistical significance for lung disease. CONCLUSION: Rituximab is a promising strategy for the SSc-associated ILD and cutaneous fibrosis treatment. PROSPERO registration number: CRD42019132018.
BACKGROUND: Systemic sclerosis (SSc) is a clinically complex and challenging disease, that leads to skin fibrosis. Its most frequent complication is interstitial lung disease (ILD), which leads to a worse prognosis. In this situation, cyclophosphamide is considered the gold standard for its treatment, despite the controversies regarding its efficacy and toxicity. However, studies using rituximab (RTX) have shown that this drug may be a promising therapeutic option. OBJECTIVES: This paper objective was to analyze the scientific evidence on the RTX effects on SSc. METHODS: A systematic review (SR) was performed including clinical trials (CTs) on the use of RTX in SSc, published up to May 2020. The studies were identified through systematic searches in bibliographic databases using a predefined search strategy. The following databases were used: PUBMED, SCOPUS, SCIELO, LILACS, SCIENCE DIRECT, WEB OF SCIENCE, COCHRANE, WHOLIS, PAHO and EMBASE. Also, a manual search was performed. The methodological quality of the studies was determined using Jadad scale, Risk of Bias Tool (RoB 2.0) and Risk of Bias in Non-Randomized Studies - of Interventions tool (ROBINS-I). A meta-analysis of the randomized CTs was performed, using Review Manager. RESULTS: Ten CTs were included in this SR. Of these, three were randomized and seven were non-randomized. Five showed a statistically significant improvement in forced vital capacity (FVC) at some time during follow-up. Regarding the skin, eight studies showed statistically significant improvements according toa the modified Rodnan skin score. The meta-analysis found positive effects of RTX in SSc, with a statistical significance for lung disease. CONCLUSION: Rituximab is a promising strategy for the SSc-associated ILD and cutaneous fibrosis treatment. PROSPERO registration number: CRD42019132018.
Authors: Maaike Boonstra; Jessica Meijs; Annemarie L Dorjée; Nina Ajmone Marsan; Anne Schouffoer; Maarten K Ninaber; Koen D Quint; Femke Bonte-Mineur; Tom W J Huizinga; Hans U Scherer; Jeska K de Vries-Bouwstra Journal: RMD Open Date: 2017-07-28
Authors: Matylda Sierakowska; Halina Doroszkiewicz; Justyna Sierakowska; Marzena Olesińska; Agnieszka Grabowska-Jodkowska; Marek Brzosko; Piotr Leszczyński; Katarzyna Pawlak-Buś; Bogdan Batko; Piotr Wiland; Maria Majdan; Małgorzata Bykowska-Sochacka; Wojciech Romanowski; Aleksandra Zon-Giebel; Sławomir Jeka; Mwidimi Ndosi Journal: Qual Life Res Date: 2019-09-03 Impact factor: 4.147