Anti-CD20 Monoclonal Antibody Therapy for Immune Modulation Across a Range of Autoimmune Diseases
Notice bibliographique
Résumé
Abstract Background: Intravenous immune globulin (IVIG) is a plasma-derived blood product that is used as a treatment for various autoimmune diseases. The anti-CD20 monoclonal antibody rituximab has similar immunomodulatory properties and mechanisms of action. We did a systematic review and meta-analysis to determine the efficacy and safety of rituximab across a broad range of autoimmune diseases with a view to investigate this agent as an alternative to IVIG. Study design: Systematic review and meta-analysis. Methods: We identified the most common indications for IVIG (besides immune replacement therapy) from a recent Ontario audit based on total amount of IVIG used. Starting with the highest users, these were: chronic inflammatory demyelinating polyneuropathy (CIDP); immune thrombocytopenia (ITP); myasthenia gravis (MG); multifocal motor neuropathy (MMN); Guillain-Barre syndrome (GBS); systemic lupus erythematosus (SLE); Sjogren's syndrome (SS); and pemphigus vulgaris (PV). Next, we did a systematic review of rituximab for each of these conditions by searching MEDLINE, EMBASE and the Cochrane Library until July 2016. Randomized controlled trials (RCT) and observational studies of ≥10 adult patients were included. The primary outcome was clinical response at 6 months from RCTs across all conditions. Secondary outcomes were clinical response for each condition and adverse events. Pooled relative risk (RCTs) or pooled proportions (observational studies) were calculated using fixed and random effects models. Risk of bias was assessed for each study using the Cochrane Collaboration tool. Results: We identified 108 studies for the target conditions (n=3536 patients) including 10 RCTs (n=1044). Most studies were in ITP (n=1543), SLE (n=1192), PV (n=504) and SS (n=200). There were 4 studies in MG (n=66), 2 studies in CIDP (n=31) and none in GBS or MMN. Risk of bias in 9 of 10 RCTs was low. Response to rituximab was 30% higher than controls (RR=1.30, 95% CI 1.01, 1.67) based on pooled results of 10 RCTs in ITP, SLE, PV and SS. Pooled proportions for disease-specific responses ranged from 48% (95%CI 30% -66%) for CIDP to 94% (95% CI 88% -98%) for PV. Adverse events were mild. Conclusion: Rituximab is an effective immune-modulating treatment and may represent an alternative to IVIG for some conditions. Few studies have been done in the rare autoimmune neurological disorders despite these being among the most frequent indications for current IVIG use. Download : Download high-res image (90KB) Download : Download full-size image Disclosures Arnold: Bristol Myers Squibb: Research Funding; Novartis: Consultancy, Research Funding; Amgen: Consultancy, Research Funding; UCB: Consultancy; Dova: Consultancy; Rigel: Consultancy.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».