A Meta-analysis Of The Efficacy And Safety Of Rituximab In The Treatment Of Lupus Nephritis

Objective: We evaluate the efficacy and safety of the drug rituxim ab in the application of lupus nephritis,and provide reliable advice and basis for clinical use.Methods: We searched Pub Med、The Cochrane library、EMbase、a nd CNKI and WANFANG to obtain controlled studies on the treatment of lupus nephritis with rituximab.The experimental group was treated with RTX,and the control group was treated with Morphine mycopheno late(MMF),corticosteroids,and cyclophosphamide(CYC).we used Rev Man 5.3 software for meta analysis.Results: This meta-analysis included a total of 6 controlled studies involving 558 patients with lupus nephritis.The two included RCT studi es were evaluated by the Cochrane risk bias assessment tool as interme diate grades.Four case-control studies were scored by NOS,and all of them had scores greater than 6 points,which were high-quality studies.The analysis results show:(1)For comparison of effectiveness,meta-a nalysis of clinical complete response in the RCT study suggested there i s no statistical difference between the two groups(P=0.46).Observation al studies analyzed clinical complete response and the results suggested statistical differences between the two groups(P=0.08).However,consid ering the risk of bias,we donnot think that the RTX group are advanta ges in improving the complete response rate.RCT studies(P=0.01)and observational studies(P=0.04)meta-analyzed the clinical total Remissio n,the results suggested that there is statistical significance between the two groups.In terms of reducing the systemic lupus erythematosus disea se activity score(SLEDAI)score,the meta-analysis results of the observational studies suggested statistical significance between the two groups(P <0.0001);about the reduction of anti-ds-DNA titers,the results of m eta-analysis of observational studies suggested that there was statistical s ignificance between the two groups(P=0.009);about the reduction of co mplement C4 level,the results of meta-analysis of the RCT studies sug gested statistical significance between the two groups(P=0.02);about de creasing serum creatinine(Scr),serum albumin(Alb),24 h urine protein levels,and decreased C3,C4 levels,The results of observational studies meta-analysis suggested no significant difference between the two grou ps.(2)Safety comparison: Observational studies were included,there wa s a statistical difference in the incidence of adverse events between the two groups(P=0.003).RTX had a lower incidence of adverse events.Conclusions: RTX combined with conventional treatment can signif icantly alleviate the activity of LN.Compared with conventional treatme nt,its overall remission rate is improved.At the same time,it can redu ce disease activity and reduce or replace the application of glucocorticoi ds and other immunosuppressants.Compared with conventional treatment alone,there were no more adverse events and its safety was better.