The efficacy and safety of rituximab in treating childhood refractory nephrotic syndrome: a meta-analysis.
The efficacy and safety of rituximab in treating childhood refractory nephrotic syndrome: a meta-analysis.
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利妥昔单抗治疗儿童难治性肾病综合征的疗效和安全性：荟萃分析
DOI：
10.1038/srep08219
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发表时间：
2015-02-03
影响因子：
4.6
通讯作者：
Zou H
中科院分区：
文献类型：
--
作者：
Zhao Z;Liao G;Li Y;Zhou S;Zou H
利妥昔单抗被认为是一种很有前途的治疗儿童难治性肾病综合征的药物。然而，利妥昔单抗治疗儿童难治性肾病综合征的疗效和安全性仍无定论。本荟萃分析旨在研究利妥昔单抗治疗难治性肾病综合征儿童的有效性和安全性，并与其他免疫抑制剂进行比较。我们的分析包括三项随机对照试验和两项比较对照研究。纳入的研究具有中等高质量。与其他免疫疗法相比，利妥昔单抗治疗显著改善了无复发生存率（风险比= 0.49，95%置信区间[CI]，0.26-0.92，P = 0.03）。利妥昔单抗也达到了较高的完全缓解率（危险比，1.62，95%CI，0.92 ~ 2.84，P = 0.09），减少蛋白尿的发生（平均差异=-0.25，95%CI =-0.29至-0.21，P < 0.00001）;然而，更有针对性的利妥昔单抗治疗并没有显着增加血清白蛋白水平，也没有显着减少不良事件。利妥昔单抗可能是儿童难治性肾病综合征的一种有前途的治疗方法;然而，利妥昔单抗治疗的长期效果和成本效益尚未得到充分评估，并且有有限的研究评估了利妥昔单抗联合类固醇同时输注与仅输注利妥昔单抗相比的临床获益。需要进行更多的研究来解决这些问题。
Rituximab is considered to be a promising drug for treating childhood refractory nephrotic syndrome. However, the efficacy and safety of rituximab in treating childhood refractory nephrotic syndrome remain inconclusive. This meta-analysis aimed to investigate the efficacy and safety of rituximab treatment compared with other immunosuppressive agents in children with refractory nephrotic syndrome. Three randomized controlled trials and two comparative control studies were included in our analysis. The included studies were of moderately high quality. Compared with other immunotherapies, rituximab therapy significantly improved relapse-free survival (hazard ratio = 0.49, 95% confidence interval [CI], 0.26–0.92, P = 0.03). Rituximab also achieved a higher rate of complete remission (risk ratio,1.62; 95% CI, 0.92 to 2.84, P = 0.09) and reduced the occurrence of proteinuria (mean difference = −0.25, 95% CI = −0.29 to −0.21, P < 0.00001); however, a more targeted rituximab treatment did not significantly increase serum albumin levels and did not significantly reduce adverse events. Rituximab might be a promising treatment for childhood refractory nephrotic syndrome; however, the long-term effects and cost-effectiveness of rituximab treatment were not fully assessed and there were limited studies that evaluated the clinical benefits of a concurrent infusion of rituximab plus a steroid compared with an infusion of rituximab only. Additional studies are required to address these issues.