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Efficacy of rituximab treatment in chronic inflammatory demyelinating polyradiculoneuropathy: a systematic review and meta-analysis

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Abstract

Background

Current standard treatment in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) has been proved effective, but it is poorly effective in refractory patients and unclear for anti-IgG4 antibody-associated CIDP. Rituximab is a B cell-depleting monoclonal antibody. It has been applied as one of the management strategies in CIDP, but its efficacy is unknown.

Objective

To perform a systematic review and a meta-analysis of the efficacy of rituximab treatment in CIDP patients.

Methods

Through searches in MEDLINE, PubMed, EMBASE, BIOSOS, Web of Science, and Cochrane library on March 31st, 2021, 15 studies were identified. Patients’ characteristics, treatment regime and outcome measure were extracted.

Results

Ninety-six patients in 15 studies were included. The pooled estimate of responsiveness was 75% (95% CI 72–78%). The standard mean difference (SMD) of Inflammatory Neuropathy Cause and Treatment (INCAT) disability score improvement was 1.7 (95% CI 1.0–2.3, p value < 0.0001) and the Medical Research Council (MRC) score for muscle power is 1.3 (95% CI − 2.6 to − 0.1, p value 0.04). All of the anti-IgG4 antibody-positive patients showed excellent responses to rituximab treatment.

Conclusion

Rituximab was effective in the treatment in CIDP patients, especially in anti-IgG4 antibody-positive patients. Randomized clinical trials are needed to determine the effectiveness and safety of rituximab in CIDP patients.

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Availability of data and materials

The data generated or used during the study are available from the corresponding author by request.

Code availability

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  1. Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China

    Jianian Hu, Chong Sun, Jiahong Lu, Chongbo Zhao & Jie Lin

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Hu, J., Sun, C., Lu, J. et al. Efficacy of rituximab treatment in chronic inflammatory demyelinating polyradiculoneuropathy: a systematic review and meta-analysis. J Neurol 269, 1250–1263 (2022). https://doi.org/10.1007/s00415-021-10646-y

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