Efficacy and safety of an anti‐CD20 monoclonal antibody, rituximab, for lupus nephritis: A meta‐analysis

Abstract Background The efficacy and safety of rituximab (RTX) for lupus nephritis are still a controversial issue. Methods We systematically searched MEDLINE, EMBASE, and the Cochrane Library databases for all clinical controlled studies. Results Six studies with 588 patients were included in our meta‐analysis. RTX increased total renal remission rates (TR, odds ratio [OR] 2.16, 95% CI 1.31 to 3.55, P = .003) and complete renal remission rate (CR, OR 2.42, 95% CI 1.18 to 4.94, P = .02) compared with the control group. Subgroup analyses showed that rituximab was more effective at increasing the rate of TR and CR for lupus nephritis patients compared with mycophenolate mofetil (TR, OR 4.6, 95% CI 1.29 to 16.47, P = .02; CR, OR 2.56, 95% CI 1.19 to 5.47, P = .02) and cyclophosphamide (TR, OR 2.89, 95% CI 1.31 to 6.40, P = .009; CR, OR 2.75, 95% CI 1.19 to 6.4, P = .02). Rituximab also had advantage in reducing Systemic Lupus Erythematosus Disease Activity Index score (–2.49, 95% CI –3.77 to –1.22, P = .0001). There were no significant differences between the RTX group and control group on the change of proteinuria (–0.36 g/d, 95% CI –0.71 to –0.00 g/d, P = .05) and serum creatinine (0.13 mg/dL, 95% CI –0.15 to 0.42 mg/dL, P = .36). RTX treatment did not increase the risk of adverse events compared to the control group. Conclusions This study provides clear beneficial effects of RTX in patients with lupus nephritis. In addition, RTX therapy did not increase the risk of adverse events compared to the control group.