Rituximab therapy for connective tissue disease-associated interstitial lung disease: a systematic review and meta-analysis

Background Rituximab (RTX) is utilized for treating connective tissue disease-associated interstitial lung disease (CTD-ILD) by eliminating pathogenic B cells, yet its clinical benefit remains debated. This study evaluates RTX's efficacy and safety in CTD-ILD. Methods A literature search was conducted in PubMed, Embase, and Cochrane Library for studies on RTX in CTD-ILD up to May 24, 2024. The Joanna Briggs Institute checklist assessed study quality. Changes in forced vital capacity (FVC%) and diffusing capacity of the lungs for carbon monoxide (DLCO%) before and after RTX use were compared, and analyzed between RTX and control groups. Results 1052 CTD-ILD patients from 40 studies were analyzed. RTX significantly improved FVC% (WMD = 7.10, 95% CI = 4.58-9.62, P < 0.05) and DLCO% (WMD = 5.26, 95% CI = 2.86-7.65, P < 0.01), and reduced the modified Rodnan skin score (mRSS) (WMD = -6.58, 95% CI = -8.27 to -4.89, P < 0.01) and prednisone dose (WMD = -6.94, 95% CI = -11.96 to -1.92, P < 0.01). Among RTX-treated patients, 30.3% improved, 45.3% remained stable, and 10.0% progressed. Adverse effects included infection (22.4%), hospitalization (6.7%), and mortality (5.0%). Conclusions RTX significantly enhances lung function in CTD-ILD patients, as shown in this systematic review and meta-analysis.