Rituximab in systemic sclerosis-associated interstitial lung disease: A systematic review and meta-analysis

BackgroundSystemic sclerosis-associated interstitial lung disease (SSc-ILD) is a prominent form of connective tissue disease-associated interstitial lung disease with high prevalence and poor prognosis. The therapeutic use of corticosteroids is often limited, and the efficacy of conventional treatment may be suboptimal in certain cases. This systematic review and meta-analysis assessed the clinical effects of rituximab in SSc-ILD compared to conventional treatments and investigated potential clinical benefits in patients with disease progression despite conventional therapy.MethodsA comprehensive literature search was conducted in Ovid MEDLINE^®, Cochrane Library, EMBASE, and KoreaMed databases to identify studies on rituximab in adult SSc-ILD patients. Comparative studies with complete trial results were included. The primary outcome was the effect of rituximab on disease progression, measured by the change in forced vital capacity (FVC) compared to conventional treatments.ResultsFrom 940 articles, six studies (two randomized, four non-randomized) were included for analysis. Standardized mean differences (SMD) were used in analyses due to the varied durations of the included studies. The meta-analysis demonstrated that rituximab reduced the FVC decline in patients with SSc-ILD compared to conventional treatment (SMD 0.65; 95% confidence interval, 0.08-1.22, P = .03), though no significant differences were found in lung diffusing capacity or modified Rodnan skin score. Rituximab showed a significantly lower incidence of leukopenia compared to cyclophosphamide (P = .02) and showed a non-significant trend toward fewer instances of pneumonia and urinary tract infections.ConclusionsThe meta-analysis revealed that rituximab may be clinically beneficial in SSc-ILD that progresses despite conventional treatment. Further research is necessary to validate the clinical benefits of rituximab in SSc-ILD.