背景:肉芽肿性多血管炎(GPA)是一种抗中性粒细胞胞浆抗体(ANCA)相关血管炎(AAV),其特征是影响中小血管的坏死性血管炎。GPA影响各种器官,呼吸道,血管炎和肾小球肾炎是最常见的三联征。GPA的缓解诱导和维持治疗传统上涉及皮质类固醇和环磷酰胺。然而,利妥昔单抗治疗,一种消耗参与自身免疫性疾病的B细胞的单克隆抗体,在几项研究中成功诱导缓解。本系统评价的目的是探讨利妥昔单抗治疗GPA各种临床表现的疗效。
方法:遵守PRISMA系统评价和荟萃分析指南,我们进行了全面综述,以研究利妥昔单抗对GPA中特定器官受累的有效性.我们搜索了三个数据库(PubMed,Scopus,和Embase),直到2022年11月6日,用于有关该主题的病例报告。为了确保包括所有相关研究,我们手动筛选了GoogleScholar搜索结果的前50页。
结果:审查确定了总共64例病例报告和113例病例系列,强调利妥昔单抗治疗GPA难治性器官受累的有效性。该综述还分析了利妥昔单抗治疗眼部的有效性,CNS,心脏,肺,皮肤,胃肠,肾,和其他器官参与GPA。
结论:我们的结果表明,利妥昔单抗可能是治疗多种器官受累的特定临床表现的有希望的疗法。然而,需要更多的研究来确定利妥昔单抗治疗GPA的长期疗效.
BACKGROUND: Granulomatosis with polyangiitis (GPA) is a type of Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) characterized by necrotizing vasculitis affecting small and medium-sized blood vessels. GPA affects various organs, with respiratory tract, vasculitis and glomerulonephritis being the most common triad. Remission induction and maintenance therapy for GPA traditionally involves corticosteroids and cyclophosphamide. However, treatment with rituximab, a monoclonal antibody that depletes B-cells involved in autoimmune disease, has been successful in inducing remission in several studies. The purpose of this systematic review was to investigate the efficacy of rituximab in treating various clinical manifestations of GPA.
METHODS: In adherence to PRISMA guidelines for systematic reviews and meta-analyses, we carried out a comprehensive review to investigate the effectiveness of rituximab on particular organ involvement in GPA. We searched three databases (PubMed, Scopus, and Embase) up until November 6, 2022, for
case reports on the topic. To ensure all relevant studies were included, we manually screened the first 50 pages of Google Scholar\'s search results.
RESULTS: The review identified a total of 64
case reports and a
case series of 113 cases, highlighting the effectiveness of rituximab in treating refractory organ involvement in GPA. The review also analyzed the effectiveness of rituximab in treating ocular, CNS, cardiac, pulmonary, cutaneous, gastrointestinal, renal, and other organ involvements in GPA.
CONCLUSIONS: Our results indicated that rituximab can be a promising therapy for treating specific clinical manifestations of several organ involvements. However, more research is needed to determine the long-term efficacy of rituximab in treating GPA.