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Efficacy and safety of rituximab in multiple sclerosis: a systematic review and meta-analysis

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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.

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Availability of data and materials

The data sets analyzed during the current study are available upon request with no restriction.

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Funding

We do not have any financial support for this study.

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Authors and Affiliations

  1. Neuroscience Research Group (NRG), Universal Scientific Education and Research Network (USERN), Tehran, Iran

    Fardin Nabizadeh & Mobin Mohamadi

  2. School of Medicine, Iran University of Medical Sciences, Tehran, Iran

    Fardin Nabizadeh & Mobin Mohamadi

  3. Neuroscience Research Center, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

    Mona Asghari Ahmadabad

  4. Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

    Omid Mirmosayyeb

  5. School of Medicine, Tehran University of Medical Science, Tehran, Iran

    Tahereh Maleki & Homa Seyedmirzaei

  6. Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran

    Kimia Kazemzadeh

  7. Interdisciplinary Neuroscience Research Program (INRP), Tehran University of Medical Sciences, Tehran, Iran

    Homa Seyedmirzaei

  8. Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran

    Homa Seyedmirzaei

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  1. Fardin Nabizadeh
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Contributions

FN, OM, TM and MA: designed the study, analyzed the data, and wrote the paper; FN, KK and HS: collected data, analyzed and interpreted the data, and wrote the draft version of the manuscript. The manuscript was revised and approved by all authors.

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Correspondence to Fardin Nabizadeh.

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Nabizadeh, F., Ahmadabad, M.A., Mohamadi, M. et al. Efficacy and safety of rituximab in multiple sclerosis: a systematic review and meta-analysis. Acta Neurol Belg 123, 2115–2127 (2023). https://doi.org/10.1007/s13760-023-02329-4

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