Rituximab in secondary progressive multiple sclerosis: a meta-analysis

IF 4.4 2区医学 Q1 CLINICAL NEUROLOGY Annals of Clinical and Translational Neurology Pub Date : 2024-08-26 DOI:10.1002/acn3.52186

Pasin Intarakhao, Taksaporn Laipasu, Jiraporn Jitprapaikulsan, Natnasak Apiraksattayakul, Punchika Kosiyakul, Sasitorn Siritho, Naraporn Prayoonwiwat, Tatchaporn Ongphichetmetha

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Abstract

Objective

To evaluate the efficacy of rituximab (RTX) in stabilizing disability progression in secondary progressive multiple sclerosis (SPMS).

Methods

A systematic review was conducted, encompassing studies from inception to April 2023, utilizing the MEDLINE and EMBASE databases. Inclusion criteria comprised studies with a minimum of 3 SPMS patients receiving intravenous RTX in at least one infusion, with a follow-up duration of at least 6 months. Primary outcome measures included changes in Expanded Disability Status Scale (EDSS) scores. Mean differences in pre- and post-RTX EDSS scores were analyzed using a random-effects model. Meta-regression examined age at RTX initiation, pre-RTX EDSS scores, disease duration, and outcome reported time as variables. Secondary outcomes assessed changes in the annualized relapse rate (ARR).

Results

Thirteen studies, involving 604 SPMS patients, met the inclusion criteria. Following a mean follow-up of 2 years, the mean difference in EDSS scores (ΔEDSS = EDSS_pre-RTX − EDSS_post-RTX) was −0.21 (95% CI −0.51 to 0.08, p = 0.16), indicating no significant variation. Multivariable meta-regression identified significant associations between EDSS score mean difference and pre-RTX EDSS scores, disease duration at RTX initiation, and outcome reported time. However, age at RTX initiation showed no significant association. Pre- and post-RTX ARR data were available for 245 out of 604 SPMS patients across seven studies, revealing a mean difference in ARR (ΔARR = ARR_pre-RTX − ARR_post-RTX) of 0.74 (95% CI 0.19–1.29, p = 0.008).

Interpretation

RTX demonstrates efficacy in reducing relapse frequency and exhibits potential in stabilizing disability progression over a 2-year follow-up, particularly among individuals with shorter disease duration.

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利妥昔单抗治疗继发性进展型多发性硬化症：一项荟萃分析。

目的评估利妥昔单抗（RTX）在稳定继发性进展性多发性硬化症（SPMS）残疾进展方面的疗效：方法：利用 MEDLINE 和 EMBASE 数据库对从开始到 2023 年 4 月的研究进行系统性回顾。纳入标准包括至少有3名SPMS患者接受过一次RTX静脉注射，随访时间至少6个月。主要结果指标包括扩展残疾状态量表（EDSS）评分的变化。采用随机效应模型分析了RTX前后EDSS评分的平均差异。元回归研究了RTX起始年龄、RTX前EDSS评分、病程和结果报告时间等变量。次要结果评估了年复发率（ARR）的变化：有13项研究符合纳入标准，涉及604名SPMS患者。平均随访2年后，EDSS评分的平均差异（ΔEDSS = EDSSpre-RTX - EDSSpost-RTX）为-0.21（95% CI -0.51至0.08，p = 0.16），表明无显著差异。多变量元回归发现，EDSS评分均值差异与RTX前EDSS评分、RTX开始时的病程以及结果报告时间之间存在显著关联。然而，开始使用 RTX 时的年龄与之无明显关联。在7项研究的604名SPMS患者中，有245名患者获得了RTX前和RTX后的ARR数据，显示ARR的平均差异（ΔARR = ARRpre-RTX - ARRpost-RTX）为0.74（95% CI 0.19-1.29，P = 0.008）：RTX在降低复发频率方面表现出疗效，并在两年随访期间表现出稳定残疾进展的潜力，尤其是在病程较短的患者中。

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来源期刊

Annals of Clinical and Translational Neurology Medicine-Neurology (clinical)

CiteScore

9.10

自引率

1.90%

发文量

218

审稿时长

8 weeks

期刊介绍： Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.