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A Systematic Review and Meta-analysis of Rituximab-Associated Infections Among Children and Adolescents With
Zhara Pouransiri1, Farahnak Assadi2, Masoumeh Mohkam3
1Pediatric Nephrology Research Center (ZP, MaM), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Insights
Rituximab (RTX) use in children with glomerular disease, including lupus nephritis and nephrotic syndrome, was linked to fewer infections compared to general populations. Further research is needed for long-term safety insights.
Area of Science:
- Pediatric Nephrology
- Immunology
- Pharmacology
Background:
- Glomerular diseases in children, such as lupus nephritis and nephrotic syndrome, can lead to significant morbidity.
- Rituximab (RTX) is an increasingly used biologic agent for managing these conditions.
- Understanding RTX-associated infectious complications is crucial for optimizing pediatric patient care.
Purpose of the Study:
- To systematically review and meta-analyze infectious complications associated with rituximab (RTX) in pediatric patients with glomerular diseases.
- To compare infection rates in children treated with RTX for lupus nephritis (LN) and nephrotic syndrome (NS) against relevant population data.
Main Methods:
- Systematic literature search of PubMed, ISI, Scopus, and EMBASE (January 2010–July 2021).
- Meta-analysis of 7 studies including 668 pediatric patients (136 with LN, 532 with NS).
- Random-effect model used due to significant heterogeneity (I² > 50%); data analyzed using Stata17.0.
Main Results:
- Rituximab (RTX) administration was associated with a significantly lower risk of infectious complications in pediatric patients with LN and NS (RR 0.72; 95% CI 0.58–0.85) compared to population data without glomerular disease.
- No significant differences in serious adverse events or infection occurrence were found between LN and NS groups.
- Significant heterogeneity was observed among the included studies (Q = 42.39, p < 0.001, I² = 81%).
Conclusions:
- Rituximab (RTX) use in children with glomerular diseases, including lupus nephritis and nephrotic syndrome, is linked to a reduced rate of infections.
- High-quality randomized controlled trials with extended follow-up are necessary to fully elucidate potential long-term complications.
- Trial registration: PROSPERO ID CRD42021274869.
Objective:
This systematic review and meta-analysis aimed to explore rituximab (RTX) associated infectious complications in children with glomerular disease.
Methods:
We performed an electronic search of PubMed, International Scientific Information (ISI), Scopus, and EMBASE between January 2010 and July 2021. Infection rates and total drug-related adverse events were the outcomes. Statistical heterogeneity was evaluated by using the I statistic. When there was statistical evidence of heterogeneity (I2 > 50%, p > 0.1), a random-effect model was adopted. Data analysis was performed with Stata17.0 software.
Results:
A total of 7 studies with 668 patients (136 with lupus nephritis [LN] and 532 with nephrotic syndrome were included in the meta-analysis. The pooled risk ratio showed that the administration of RTX was significantly associated with lower risk of infectious complications in patients with LN and nephrotic syndrome (0.72 [95% CI 0.58, 0.85]) when compared with population data of patients without glomerular disease (p = 0.2). There was no significant difference between the LN and nephrotic syndrome groups in terms of total serious adverse events or the occurrence of infections. There was significant heterogeneity among the reported studies (Q = 42.39, p < 0.001, I2 = 81%).
Conclusion:
Administration of RTX in children with glomerular disease is associated with a lower rate of infections when compared with population data of patients without LN or nephrotic syndrome. Additional high-quality randomized controlled trials with long-term follow-up are needed to identify the long-term potential complications. Trial registration PROPERO ID: CRD42021274869 (https://www.crd.york.ac/prospero/display_record.php?).
