Low-Dose Rituximab in the Treatment of Primary Membranous Nephropathy - A Systematic Review and Meta-Analysis.

Gerry George Mathew, Shanmugam Sundaramurthy, Prakash Muthuperumal, V Jayaprakash
{"title":"Low-Dose Rituximab in the Treatment of Primary Membranous Nephropathy - A Systematic Review and Meta-Analysis.","authors":"Gerry George Mathew, Shanmugam Sundaramurthy, Prakash Muthuperumal, V Jayaprakash","doi":"10.69097/41-05-2024-04","DOIUrl":null,"url":null,"abstract":"<p><p><b>Introduction.</b> Rituximab (RTX) holds promise as a treatment for idiopathic membranous nephropathy (IMN). While effective in standard regimens, the application of RTX is hampered by cost burdens and severe side effects. To address these issues, low-dose RTX has been proposed as an intervention strategy. Yet, the efficacy of this approach in treating IMN remain subject of debate. This systematic review and meta-analysis seek to examine the effectiveness of low-dose RTX in adult patients with IMN. <b>Methodology.</b> A literature search was conducted using PubMed, Wiley Online Library, ScienceDirect, Cochrane Library, Springer and other sources, published between 2004 and 2024. Specifically, articles reporting the intravenous application of RTX at doses lower than four weekly infusions of 375 mg/m² or two infusions of 1 gram each on day 0 and day 15 were considered for inclusion. The primary outcomes were complete response (CR) and partial response (PR) rates at last follow-up. Secondary endpoints included serum creatinine levels, serum albumin levels, 24-hour proteinuria levels, protein-creatinine ratio (PCR), estimated glomerular filtration rate (eGFR) and anti-PLA2R antibody levels. <b>Results.</b> Sixteen articles were included in this meta-analysis. The pooled analysis of odds ratios (OR) revealed that both main-line (OR = 0.48, 95% CI = 0.30-0.75, p = 0.001) and second-line (OR = 0.27, 95% CI = 0.11-0.67, p = 0.005) RTX treatments induced complete remission (CR) in IMN patients. At the last follow-up, patients treated with both main-line (mean difference [MD] = 1.45, 95% CI = 1.00-1.91, p < 0.00001) and second-line (MD = 0.88, 95% CI = 0.23-1.53, p < 0.00001) RTX treatments showed a significant increase in serum albumin levels. Conversely, in the analysed second line RTX therapy patients, low eGFR trend was noted in the post treatment arm compared to baseline levels (MD = 10.57, 95% CI = 0.30-20.83, p = 0.04). Moreover, RTX was found to be effective in reducing PCR (MD = 24.10, 95% CI= 1.07 to 47.13, p = 0.04) and depleting PLA2R antibody levels (MD = 127.36, 95% CI = 14.90-239.81, P = 0.03). However, RTX might be less effective in lowering proteinuria and serum creatinine levels in patients with nephrotic syndrome. <b>Conclusion.</b> Rituximab in a low-dose regimen is quite effective in treating adult patients with IMN. Therefore, it can be considered a promising treatment for both main-line and rescue therapy. More randomized controlled trials and research on optimizing the low-dose regimen, based on various health factors, are warranted.</p>","PeriodicalId":12553,"journal":{"name":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","volume":"41 5","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Giornale italiano di nefrologia : organo ufficiale della Societa italiana di nefrologia","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.69097/41-05-2024-04","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0

Abstract

Introduction. Rituximab (RTX) holds promise as a treatment for idiopathic membranous nephropathy (IMN). While effective in standard regimens, the application of RTX is hampered by cost burdens and severe side effects. To address these issues, low-dose RTX has been proposed as an intervention strategy. Yet, the efficacy of this approach in treating IMN remain subject of debate. This systematic review and meta-analysis seek to examine the effectiveness of low-dose RTX in adult patients with IMN. Methodology. A literature search was conducted using PubMed, Wiley Online Library, ScienceDirect, Cochrane Library, Springer and other sources, published between 2004 and 2024. Specifically, articles reporting the intravenous application of RTX at doses lower than four weekly infusions of 375 mg/m² or two infusions of 1 gram each on day 0 and day 15 were considered for inclusion. The primary outcomes were complete response (CR) and partial response (PR) rates at last follow-up. Secondary endpoints included serum creatinine levels, serum albumin levels, 24-hour proteinuria levels, protein-creatinine ratio (PCR), estimated glomerular filtration rate (eGFR) and anti-PLA2R antibody levels. Results. Sixteen articles were included in this meta-analysis. The pooled analysis of odds ratios (OR) revealed that both main-line (OR = 0.48, 95% CI = 0.30-0.75, p = 0.001) and second-line (OR = 0.27, 95% CI = 0.11-0.67, p = 0.005) RTX treatments induced complete remission (CR) in IMN patients. At the last follow-up, patients treated with both main-line (mean difference [MD] = 1.45, 95% CI = 1.00-1.91, p < 0.00001) and second-line (MD = 0.88, 95% CI = 0.23-1.53, p < 0.00001) RTX treatments showed a significant increase in serum albumin levels. Conversely, in the analysed second line RTX therapy patients, low eGFR trend was noted in the post treatment arm compared to baseline levels (MD = 10.57, 95% CI = 0.30-20.83, p = 0.04). Moreover, RTX was found to be effective in reducing PCR (MD = 24.10, 95% CI= 1.07 to 47.13, p = 0.04) and depleting PLA2R antibody levels (MD = 127.36, 95% CI = 14.90-239.81, P = 0.03). However, RTX might be less effective in lowering proteinuria and serum creatinine levels in patients with nephrotic syndrome. Conclusion. Rituximab in a low-dose regimen is quite effective in treating adult patients with IMN. Therefore, it can be considered a promising treatment for both main-line and rescue therapy. More randomized controlled trials and research on optimizing the low-dose regimen, based on various health factors, are warranted.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
治疗原发性膜性肾病的小剂量利妥昔单抗--系统回顾和元分析。
简介利妥昔单抗(RTX)有望治疗特发性膜性肾病(IMN)。虽然 RTX 在标准方案中效果显著,但其应用却受到成本负担和严重副作用的阻碍。为了解决这些问题,有人提出将低剂量 RTX 作为一种干预策略。然而,这种方法治疗 IMN 的疗效仍存在争议。本系统综述和荟萃分析旨在研究低剂量 RTX 对 IMN 成年患者的疗效。研究方法。使用 PubMed、Wiley Online Library、ScienceDirect、Cochrane Library、Springer 和其他来源对 2004 年至 2024 年间发表的文献进行检索。具体而言,考虑纳入报道静脉注射 RTX 的文章,剂量低于每周输注四次,每次 375 毫克/平方米,或在第 0 天和第 15 天各输注两次,每次 1 克。主要结果是最后一次随访时的完全应答率(CR)和部分应答率(PR)。次要终点包括血清肌酐水平、血清白蛋白水平、24小时蛋白尿水平、蛋白-肌酐比值(PCR)、估计肾小球滤过率(eGFR)和抗PLA2R抗体水平。结果。本次荟萃分析共纳入 16 篇文章。对几率比(OR)的汇总分析显示,主线(OR = 0.48,95% CI = 0.30-0.75,p = 0.001)和二线(OR = 0.27,95% CI = 0.11-0.67,p = 0.005)RTX治疗均可诱导IMN患者完全缓解(CR)。在最后一次随访中,接受一线(平均差[MD] = 1.45,95% CI = 1.00-1.91,p < 0.00001)和二线(MD = 0.88,95% CI = 0.23-1.53,p < 0.00001)RTX 治疗的患者血清白蛋白水平均显著上升。相反,在分析的二线 RTX 治疗患者中,与基线水平相比,治疗后治疗组的 eGFR 呈下降趋势(MD = 10.57,95% CI = 0.30-20.83,p = 0.04)。此外,研究还发现 RTX 能有效降低 PCR(MD = 24.10,95% CI= 1.07 至 47.13,P = 0.04)和消耗 PLA2R 抗体水平(MD = 127.36,95% CI = 14.90 至 239.81,P = 0.03)。不过,RTX 在降低肾病综合征患者蛋白尿和血清肌酐水平方面的效果可能较差。结论低剂量利妥昔单抗治疗成年 IMN 患者相当有效。因此,无论是作为主线治疗还是抢救治疗,利妥昔单抗都是一种很有前景的治疗方法。有必要进行更多的随机对照试验,并根据各种健康因素对低剂量方案进行优化研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
CiteScore
0.70
自引率
0.00%
发文量
62
期刊介绍: Il Giornale Italiano di Nefrologia (GIN) è la rivista di educazione continua della Società Italiana di Nefrologia SIN ed è pubblicato bimestralmente. E" il più autorevole organo di informazione nefrologia disponibile a livello nazionale. Il giornale Italiano di Nefrologia offre la più aggiornata informazione medico-scientifica rivolta al nefrologo sotto forma di rassegne, casi clinici e articoli finalizzati all’Educazione Continua in Medicina, oltre ai notiziari ed agli atti dei congressi di questa prestigiosa Società Scientifica
期刊最新文献
[ANCA-Associated Glomerulonephritis Following SARS-CoV2 Infection: A Case Report]. [Governo clinico in nefrologia: organizzazione e sviluppo della dialisi peritoneale]. [Hypotension and Generalized Edema Due to Plasma Leakage: A Case Report]. [Reactive Perforating Collagenosis in Hemodialysis Patients]. [Survey and Intervention Tools for Burnout in Dialysis Healthcare Staff].
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1