Meta-analysis of the effectiveness of rituximab and cyclophosphamide combined with azathioprine in the treatment of anti-neutrophil cytoplasmic antibodies-related vasculitis / 中华风湿病学杂志

ABSTRACT

Objective:To evaluate the effectiveness and safety of rituximab (RTX) and cyclophosphamide/azathioprine (CYC/AZA) in the treatment of anti-neutrophil cytoplasmic antibody (ANCA)-related vasculitis (AAV).Methods:After setting up the search strategy, the inclusion and screening criteria of the literature were determined, the Pubmed, Cochrane Library, Embase, China Biomedical Literature Database, CNKI, Wanfang Database, Weipu Database were searched for RTX and CYC/AZA treatment for AAV. For randomized controlled studies, in which the experimental group was RTX for AAV, and the control group was CYC/AZA for AAV were included. The retrieval time span was from January 2000 to June 2021, and the data obtained were analyzed using Revman 5.3 software.Results:A total of 9 articles and 4 studies were included, with a total of 384 patients, including 203 cases in the experimental group and 181 cases in the control group. In the treatment of AAV, the difference in the remission rate of RTX and CYC/AZA treatment of AAV was statistically significant, and the remission rate of the RTX group was higher [ OR(95% CI)=1.58(1.03, 2.40), P=0.03]. For the remission rates of different types of AAV, RTX and CYC/AZA were benefit for the treatment of granulomatous vasculitis, microscopic polyangiitis, eosinophilic granulomatous vasculitis, there was no statistically significant difference in the remission rate of patients with protease 3-related vasculitis and myeloperoxidase-related vasculitis. The incidence of granulocytopenia in the RTX group was significantly lower than that in the CYC/AZA group, and RTX treatment could reduce the incidence of other serious adverse reactions. Conclusion:For the remission induction therapy, RTX is not inferior to CYC for all subtypes of AAV. In the maintenance treatment phase, RTX has a higher remission rate and a lower recurrence rate. During the entire treatment process, patients who were treated with RTX had a higher long-term remission rate than patients who were not treated with RTX. RTX can effectively reduce the occurrence of adverse reactions such as neutropenia.