Assessing Efficacy, Safety and Tolerability of Rituximab for Rheumatoid Arthritis: Meta-Analyses of Randomized Controlled Trials

Rheumatoid arthritis is a chronic disease with autoimmune nature. Rituximab is one of several pharmacological and nonpharmacological interventions which are used for its treatment and control. The aim of this study was to assess the efficacy, safety and tolerability of rituximab in the treatment of rheumatoid arthritis. A systematic review (up to June 2011) and meta-analyses were performed which included randomized controlled clinical trials that compared rituximab versus placebo, both with concomitant methotrexate. Only high or moderate quality studies were included. The efficacy was evaluated based on changes in ACR20, 50 and 70; the safety was assessed based on serious adverse events; and the tolerability was evaluated by the withdrawals due to adverse events. All these parameters were evaluated within 24 weeks of treatment. Four studies met the inclusion criteria, comprising 1 280 patients. The rituximab group presented higher efficacy results for ACR20, ACR50 and ACR70 (Relative Risk (RR) of 2,24 [1,86; 2,71], 3,29 [2,31; 4,68] and 3,90 [1,88; 8,09], respectively). For serious adverse events no significant difference between the groups was noticed ( RR = 0,83 [0,54; 1,26]. For withdrawals due to AE, no statistically significant difference between the groups was obtained either ( RR = 1,49 [0,46; 4,84]. In conclusion, the rituximab showed a higher efficacy compared to placebo without significant differences between the groups in terms of safety and tolerability.