Rituximab in systemic lupus erythematosus: an updated systematic review and meta-analysis
Rituximab in systemic lupus erythematosus: an updated systematic review and meta-analysis
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DOI：
10.1177/0961203313509295
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发表时间：
2013-12-01
期刊：
影响因子：
2.6
通讯作者：
Chizzolini, C.
中科院分区：
文献类型：
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作者：
Duxbury, B.;Combescure, C.;Chizzolini, C.
广泛的临床表现和高复发率是系统性红斑狼疮(SLE)治疗的一个挑战。观察性研究表明，利妥昔单抗(RTX)是一种B细胞靶向抗体，可以有效控制SLE的活动。两个安慰剂对照的随机试验没有证明RTX在非肾性(探索者)和肾性(月球)狼疮常规治疗之外的优越性。对探讨RTX对SLE患者疗效的研究进行了系统综述。评估了反应的集合百分比。对1243例患者的30项研究进行了分析。在使用不列颠群岛狼疮评估组(BILAG)的研究中，完全缓解(CR)率为46.7%(95%可信区间为36.8%~56.8%)，部分缓解(PR)为37.9%(95%可信区间为30.6%~45.8%)。以系统性红斑狼疮疾病活动指数(SLEDAI)计算，CR为56.6%(95%CI为32.4%~78.1%)，PR为30.9%(95%CI为8.9%~46%)。肾性狼疮的CR为36.1%(95%CI 25.2%~48.6%)，PR为37.4%(95%CI 28.5%~47.3%)。探测器组CR为12.4%，PR为17.2%，月球CR为26.4%，PR为30.6%，与对照组比较差异无统计学意义。对系统性红斑狼疮治疗反应的评估和标准化仍然是一个挑战。在对照研究和观察性研究中，RTX的感知疗效的差异反映了狼疮的异质性和对反应标准的严格。有必要进行进一步的随机试验，重点放在选定的系统性红斑狼疮表现上，并使用综合反应指数。
The wide spectrum of clinical manifestations and high relapse rate represent a therapeutic challenge in systemic lupus erythematosus (SLE). Observational studies suggested efficacy of rituximab (RTX), a B-cell-targeting antibody, to control the activity of SLE. Two randomized trials controlled by placebo did not prove the superiority of RTX when used in addition to conventional treatment in nonrenal (EXPLORER) and renal (LUNAR) lupus. A systematic review of studies exploring the efficacy of RTX in SLE patients was conducted. The pooled percentages of response were assessed. Thirty studies with 1243 patients were analyzed. In studies using the British Isles Lupus Assessment Group (BILAG), the complete response (CR) rate was 46.7% (95% CI 36.8%-56.8%) and the partial response (PR) was 37.9% (95% CI 30.6%-45.8%). With the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), the CR was 56.6% (95% CI 32.4%-78.1%) and the PR was 30.9% (95% CI 8.9%-46%). In renal lupus the CR was 36.1% (95% CI 25.2%-48.6%); PR was 37.4% (95% CI 28.5%-47.3%). In EXPLORER, CR was 12.4% and PR was 17.2%; in LUNAR CR was 26.4% and PR was 30.6%, in both cases not different from controls. Assessment and standardization of SLE response to treatment remain a challenge. The discrepancy in the perceived efficacy of RTX between controlled and observational studies reflects the heterogeneity of lupus and stringency in criteria of response. Further randomized trials focusing on selected SLE manifestations and using composite response indices are warranted.