Systematic Review And Meta-analysis Of Rituximab In Children With Refractory Nephrotic Syndrome

Objective:Rituximab(RTX)is a chimeric anti-CD20 monoclonal antibody.This article aims to evaluate the effect and safety of RTX in the treatment of children with refractory nephrotic syndrome,and to provide references and evidences for clinical rational use of rituximab in children with nephrotic syndrome.Methods:PubMed,Web of Science,Cochrane Library,EMBASE,and Chinese Biomedical Literature Database were searched from the inception of the database to November 1,2019,the conducted literatures put emphasis on rituximab for the treatment of nephrotic syndrome.The literatures were selected basing on the predesigned inclusion and exclusion criteria,the patients in the control group received conventional treatment,and in intervention group received RTX in addition to conventional treatment.Then the Cochrane Bias Risk Assessment Tool was selected for evaluating the quality and bias of the included literatures,the baseline data and outcome data were extracted.Finally,RevMan 5.3 software was used to perform a metaanalysis on the extracted data and discuss the analysis results.Results:There were 5 multicenter and 1 single center randomized controlled trials met the inclusion criteria.The quality of the included studies was evaluated as moderate.Compared with the control group,RTX significantly reduced nephrotic syndrome relapses after the treatment(Odds Ratio 0.11,95% Confidence Interval [0.03,0.43],P = 0.001).Simultaneously,rituximab reduced the patient number of steroid and calcineurin inhibitors(Odds Ratio 0.05,95% Confidence Interval [0.01,0.28],P = 0.0007).Even though patients who depended on steroid to complete remission,rituximab remarkably reduce the dose of steroid(Standard Mean Difference-1.49,95% Confidence Interval [-2.00,-0.99],P <0.0001).The proteinuria after rituximab treatment was lower than control group,regrettably there were no statistically significant difference(Standard Mean Difference-0.33,95% Confidence Interval [-0.71,0.04],P = 0.08).Fewer included literatures reported the adverse effects of rituximab and most of them were slight.Conclusion:Rituximab is a safe and effective medication for children with refractory nephrotic syndrome,which could reduce the relapses,the use of immunosuppressants,and the dosage of steroid.However,proteinuria is not different from other conventional medicine for renal disease.The long-term follow up effects and cost economic effects of RTX have not been fully evaluated,and additional researches are eager to figure out these issues.