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. K E Y W O R D Sinfection, rheumatoid arthritis, rituximab, serious infection

Rituximab for recurrence of primary focal segmental glomerulosclerosis after kidney transplantation: Results of a nationwide study

“…53,54 In our study, we observed a high rate of severe infections (75.7%), mainly of bacterial origin (61.5%). Consistent with reassuring data from the literature, 57,58 this high rate does not seem related to the specific use of RTX but could be explained by the underlying disease or the associated immunosuppression. In multivariable analysis, the rate of infection was associated with low rates of gamma globulins at 3 months, which could be due to nephrotic syndrome 59 or both RTX 60,61 and PP.…”

Risk for infections with glucocorticoids and DMARDs in patients with rheumatoid arthritis

“…Pooled analysis of cohort and randomised studies showed no significant differences between rituximab and other treatment groups both in overall infections and in serious infections (4.1% vs 4.6%; OR 1.05; 95% CI 0.84 to 1.31). 24 A Cochrane review of eight trials in rituximab in conjunction with methotrexate for RA compared with methotrexate alone showed no significant difference in the risk of all infections (relative risk [RR] 1.1, 95% CI 0.95 to 1.30) or serious infections (RR 0.68, 95% CI 0.42 to 1.10). 25 One observational study suggested a higher risk of infection with rituximab compared with other biologics, although this has not been found in other observational studies.…”

Position statement for a pragmatic approach to immunotherapeutics in patients with inflammatory skin diseases during the coronavirus disease 2019 pandemic and beyond

“…Rituximab has specific risks based on its mechanism of action; however, it has not shown additional risk of acquiring infection in patients with rheumatoid arthritis 44 or bullous diseases 45 . A low‐dose regimen (500–1000 mg ×2) used in dermatology may result in fewer infections than the standard dose used in haematology (375 mg/m 2 weekly ×4) 46 .…”