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Systematic Review ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Immunol. | doi: 10.3389/fimmu.2019.01990

Systematic review of safety and efficacy of rituximab in treating immune-mediated disorders

 Céline Kägi1, Benjamin Wurst1, Jens Schreiner1, Urs Steiner1,  Alessandra Vultaggio2,  Andrea Matucci2, Catherine Crowley1 and  Onur Boyman3*
  • 1Department of Immunology, University Hospital Zurich, Switzerland
  • 2Department of Biomedicine, Hospital Universitario Careggi, Italy
  • 3University of Zurich, Switzerland

Background: During the past years biologic agents (also termed biologicals or biologics) have become a crucial treatment option in immunological diseases. Numerous articles have been published on biologicals, which complicates the decision making process on the use of the most appropriate biologic for a given immune-mediated disease. This systematic review is the first of a series of articles assessing the safety and efficacy of B cell-targeting biologics for the treatment of immune-mediated diseases.
Objective: To evaluate rituximab's safety and efficacy for the treatment of immune-mediated disorders compared to placebo, conventional treatment or other biologics.
Methods: The PRISMA checklist guided the reporting of the data. We searched the PubMed database between 4 October 2016 and 26 July 2018 concentrating on immune-mediated disorders.
Results: The literature search identified 19’665 articles. After screening titles and abstracts against the inclusion and exclusion criteria and assessing full texts, 105 articles were finally included in a narrative synthesis.
Conclusions: Rituximab is both safe and effective for the treatment of acquired angioedema with C1-inhibitor deficiency, ANCA-associated vasculitis, autoimmune hemolytic anemia, Behçet’s disease, bullous pemphigoid, Castleman’s disease, cryoglobulinemia, Goodpasture’s disease, IgG4-related disease, immune thrombocytopenia, juvenile idiopathic arthritis, membraneous nephropathy, relapsing-remitting multiple sclerosis, myasthenia gravis, nephrotic syndrome, neuromyelitis optica, pemphigus, rheumatoid arthritis, spondyloarthropathy, and systemic sclerosis. Conversely, rituximab failed to show an effect for antiphospholipid syndrome, autoimmune hepatitis, IgA nephropathy, inflammatory myositis, primary progressive multiple sclerosis, systemic lupus erythematosus, and ulcerative colitis. Finally, mixed results were reported for primary Sjögren’s syndrome and Graves’ disease, therefore warranting better quality trials with larger patient numbers.

Keywords: rituximab, Anti CD20 monoclonal antibody, Immune mediated diseases, B cell, autoimmune disease, inflammatory disease

Received: 28 Mar 2019; Accepted: 06 Aug 2019.

Copyright: © 2019 Kägi, Wurst, Schreiner, Steiner, Vultaggio, Matucci, Crowley and Boyman. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Onur Boyman, University of Zurich, Zürich, Switzerland, onur.boyman@uzh.ch