Efficacy and Safety of Rituximab in Multiple Sclerosis: A Systematic Review and Meta-Analysis Publisher Pubmed



Nabizadeh F^{1, 2} ; Ahmadabad MA³ ; Mohamadi M^{1, 2} ; Mirmosayyeb O⁴ ; Maleki T⁵ ; Kazemzadeh K⁶ ; Seyedmirzaei H^{5, 7, 8}
Source: Acta Neurologica Belgica Published:2023

Abstract

Objective: We aimed to synthesize all available observational studies and clinical trials of rituximab to estimate the safety and efficacy of this monoclonal antibody in people with multiple sclerosis (MS). Methods: The four databases including PubMed, Scopus, Embase, and Web of Science were comprehensively searched in April 2022. We defined PICO as follows. Problem or study population (P): patients with MS; intervention (I): Rituximab; comparison (C): none; outcome (O): efficacy and safety. Results: After two-step screening, a total of 27 studies entered into our qualitative and quantitative synthesis. Our analysis showed a significant decrease in EDSS score in all patients with MS after treatment (SMD: − 0.44, 95% CI − 0.85, − 0.03). In addition, the ARR was reduced after using rituximab compared to the pre-treatment period (SMD: − 0.65, 95% CI − 1.55, 0.24) but it was not significant. The most common side effect after rituximab with a pooled prevalence of 28.63% (95% CI 16.61%, 42.33%). Furthermore, the pooled prevalence of infection was 24% in patients with MS (95% CI 13%, 36%). In the end, the pooled prevalence of malignancies after rituximab treatment was 0.39% (95% CI 0.02%, 1.03%). Conclusion: Our findings illustrated an acceptable safety for this treatment. However, further studies with randomized design, long follow-up, and large sample sizes are needed to confirm the safety and efficacy of rituximab in patients with MS. © 2023, The Author(s) under exclusive licence to Belgian Neurological Society.