Rituximab for connective tissue disease‐associated interstitial lung disease: A systematic review and meta‐analysis.

Objective: To assess the efficacy of rituximab (RTX) on lung function and the prevalence of adverse events (AEs) in connective tissue disease‐associated interstitial lung disease (CTD‐ILD) by meta‐analysis. Methods: EMBASE, Web of Science, PubMed and ClinicalKey were searched up to July 16, 2021. The lung function (forced vital capacity, FVC% predicted, and diffusing capacity of the lung for carbon monoxide, DLCO% predicted) and prevalence of AEs of RTX in CTD‐ILD were analyzed by meta‐analysis, and 95% confidence interval (CI) was calculated. Subgroup analyses and meta‐regression were used to explore the heterogeneity. Results: We identified 29 studies, including 827 CTD‐ILD patients with a median age of 53.05 years. In observational studies, FVC% (mean difference − 1.24, 95% CI [−2.35, −0.12]; P =.030) and DLCO% (−7.71, [−11.79, −3.63]; P =.014) of CTD‐ILD decreased significantly after RTX treatment. In randomized controlled trials, FVC% of CTD‐ILD decreased after RTX treatment (−5.24, [−9.94, − 0.54]; P =.029), but the difference of DLCO% was not significant (1.15, [−4.33, 6.63]; P =.681). The prevalence of AEs, all‐cause mortality and infections was 29.7% (95% CI [0.17, 0.42]), 11.6% (95% CI [0.08, 0.16]) and 20.9% (95% CI [0.15, 0.27]), respectively. Conclusions: RTX was associated with AEs such as decreased pulmonary function, all‐cause mortality, and infections in CTD‐ILD. Adverse reactions during and after RTX treatment should be carefully monitored. Further prospective studies are needed to compare RTX with other immunosuppressants, antifibrotic drugs or placebos, which can provide therapeutic approaches for CTD‐ILD. [ABSTRACT FROM AUTHOR]