Is rituximab effective for systemic sclerosis? A systematic review and meta-analysis

Area of Science:

• Rheumatology
• Immunology
• Pulmonology

Background:

• Systemic sclerosis (SSc) is a complex fibrotic disease with interstitial lung disease (ILD) as a frequent, severe complication.
• Current treatments like cyclophosphamide have efficacy and toxicity concerns.
• Rituximab (RTX) is emerging as a potential therapeutic option for SSc.

Purpose of the Study:

• To systematically analyze existing scientific evidence on the efficacy of rituximab (RTX) in treating systemic sclerosis (SSc).
• To evaluate RTX's impact on both the lung and skin manifestations of SSc.

Main Methods:

• A systematic review of clinical trials (CTs) investigating RTX for SSc, published up to May 2020.
• Searches across multiple bibliographic databases (e.g., PubMed, Embase) and manual searches were conducted.
• Methodological quality assessed using Jadad scale, RoB 2.0, and ROBINS-I; meta-analysis performed on randomized CTs.

Main Results:

• Ten CTs (3 randomized, 7 non-randomized) were included.
• Five studies reported significant improvements in forced vital capacity (FVC), indicating positive effects on lung function.
• Eight studies demonstrated statistically significant improvements in the modified Rodnan skin score, showing efficacy in treating cutaneous fibrosis.
• Meta-analysis confirmed positive effects of RTX in SSc, particularly for lung disease.

Conclusions:

• Rituximab (RTX) represents a promising therapeutic strategy for managing SSc-associated ILD.
• RTX also shows significant potential in treating cutaneous fibrosis in patients with systemic sclerosis.
• Further research supports RTX as a viable option for SSc complications.