Efficacy and safety of rituximab in children with steroid-dependent or frequently relapsing nephrotic syndrome: a meta-analysis of randomized controlled trials

Introduction: To explore the efficacy and safety of rituximab (RTX) in children with steroid-dependent nephrotic syndrome (SDNS) or frequently relapsing nephrotic syndrome (FRNS) through meta-analysis. Material and methods: Meta-analysis searches were performed before November 30th, 2021, using the PubMed, Embase, Web of Science, and Cochrane Library databases to collect randomized controlled trials (RCTs). FRNS or SDNS children younger than 18 years of age were included. The RTX group was treated with RTX combined with conventional therapy, whereas the control group was given conventional therapy. Review Manager 5.3 and STATA 15.0 were used to perform the statistical analyses. Results: Of 1450 screened articles, a total of eight studies eligible for inclusion involving 476 patients were included. As compared to the control group (RR = 1.91, 95% CI: 1.16, 3.14, p < 0.05), RTX did not show significant improvement in the short term (RR = 2.48, 95% CI: 0.85, 7.25, p = 0.10). However, the RTX group achieved a higher short-term complete remission rate when two studies with heterogeneity were excluded (RR = 2.17, 95% CI: 1.65, 2.84, p < 0.001). Proteinuria levels were reduced more effectively in the RTX group (MD = -1.84, 95% CI: -2.42, -1.26, p < 0.001). The RTX group and the control group had no significant differences in adverse events. Conclusions: RTX can be considered as an effective and safe treatment option for children with SDNS or FRNS. However, it is necessary to conduct further studies via RCTs to evaluate the persistent long-term effects.