Infection risks of rituximab versus non‐rituximab treatment for rheumatoid arthritis: A systematic review and meta‐analysis

Abstract Objective The aim of this study was to assess the differences in infection rates between rituximab (RTX) and non‐RTX treatment in patients with rheumatoid arthritis (RA). Methods A systematic review and meta‐analysis was conducted by searching databases of PubMed, MEDLINE, EMBASE, Web of Science and Cochrane Library through to June 2018. We included studies that compared RTX and non‐RTX treatment for patients with RA. Outcome measures were overall infections and serious infections between RTX and non‐RTX treatments. Results A total of 11 articles, including 9502 patients (4595 with RTX treatment and 4907 with non‐RTX treatment) met our inclusion criteria. The results demonstrated that RTX‐related all infections and serious infections in RA patients were 43.8% and 4.4%, respectively. Pooled analysis showed no significant differences between RTX and non‐RTX treatment groups in overall infections rate (43.3% vs 44.9%; odds ratio [OR] = 0.87; 95% CI = 0.70‐1.08) and serious infections rate (4.1% vs 4.6%; OR = 1.05; 95% CI = 0.84‐1.31). Subgroup analysis also showed no significant differences in overall infections between RTX versus placebo (OR = 0.98, 95% CI = 0.71‐1.33); RTX versus tumor necrosis factor inhibitors (TNFi) (OR = 0.47, 95% CI = 0.30‐1.73); RTX plus methotrexate (MTX) versus placebo plus MTX (OR = 0.98, 95% CI = 0.77‐1.24), and in serious infections between RTX versus placebo (OR = 1.06, 95% CI = 0.36‐3.07); RTX versus TNFi (OR = 1.25, 95% CI = 0.96‐1.63); RTX plus MTX versus placebo plus MTX (OR = 0.69, 95% CI = 0.39‐1.20). Conclusion In patients with RA , RTX treatment has no additional risks for infections over non‐RTX treatment.