Pemphigus is a life-threatening autoimmune blistering disease affecting the skin and mucosa. Patients with severe pemphigus require long-term treatment with corticosteroids and other immunosuppressive drugs, which can lead to serious adverse events. Rituximab, a monoclonal antibody directed against the CD20 antigen of B lymphocytes, has been demonstrated to be effective in recalcitrant and life-threatening pemphigus.
Antibodies, Monoclonal, Murine-Derived ; adverse effects ; therapeutic use ; Antigens, CD20 ; immunology ; Humans ; Pemphigus ; therapy ; Rituximab

Antibodies, Monoclonal, Murine-Derived ; therapeutic use ; Humans ; Purpura, Thrombotic Thrombocytopenic ; therapy ; Rituximab

Adult ; Antibodies, Monoclonal, Murine-Derived ; administration & dosage ; therapeutic use ; Female ; Hemophilia A ; drug therapy ; Humans ; Rituximab

BACKGROUNDRituximab in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly prolonged event-free survival in first-line chemotherapy for patients with diffuse large B-cell lymphoma (DLBCL). But relapse and refractory DLBCL occur frequently. Although rituximab is effective, its role in salvage therapy after autologous transplant remains unclear. Maintenance therapy with rituximab in responding patients after first line chemotherapy may be a useful novel approach capable of eradicating minimal residual disease and to bring survival benefit. This systematic review and meta-analysis evaluated the effects of rituximab maintenance treatment and salvage therapy of patients with DLBCL.

METHODSWe performed a systematic review and meta-analysis of randomized controlled trials and compared rituximab maintenance or salvage therapy at relapse with observation. We searched the Cochrane Library, PubMed, EMBASE, conference proceedings, databases of ongoing trials, and references of published trials. Two reviewers independently assessed the quality of the trials and extracted data. Hazard ratios for time-to-event data were estimated and pooled.

RESULTSSeven trials including 1470 DLBCL patients were included in this systematic review and meta-analysis. Patients treated with maintenance rituximab have better overall survival (OS) and event-free survival (EFS) than patients in the observation arm, but there was no statistical significance. Patients who received rituximab salvage therapy for relapse or refractory DLBCL have statistically significantly better OS [HR of death = 0.72, 95% CI (0.55-0.94), P = 0.02], progression-free survival (PFS) [HR = 0.61, 95% CI (0.52-0.72), P < 0.05], odds ratio (OR) [RR = 1.26, 95% CI (1.07-1.47), P = 0.004] than patients in the observation arm. The rate of infection-related adverse events was higher with rituximab treatment [RR = 1.37, 95% CI = (1.14 - 1.65) P =0.001].

CONCLUSIONSAfter first-line chemotherapy, the two rituximab-combined treatment strategies, including maintenance and salvage therapies can bring survival benefit. But due to the few studies, the low methodological quality assessment and the low outcome evidence quality, it's not confirmed that the two strategies are better than normal chemotherapy regimens. More high-quality randomized controlled trials are still needed to provide reliable evidence. The higher rate of infections after rituximab therapy should be taken into consideration when making treatment decisions.

Antibodies, Monoclonal, Murine-Derived ; therapeutic use ; Humans ; Kidney Diseases ; therapy ; Nephrotic Syndrome ; therapy ; Rituximab

OBJECTIVETo evaluate the effectiveness, safety as well as the immunological change (peripheral T cell subpopulation) in patients with idiopathic thrombocytopenic purpura (ITP) treated with lower dose rituximab.

METHODSTwenty-six patients with refractory ITP which were unresponsive to or relapse after steriod and IVIG treatment were treated with rituximab (100 mg per week for four weeks) and intravenous immunoglobulin (IVIG) treatment. Whole blood cell count, serum concentrations of IgG, IgM and IgA, platelet associated (PA)-IgG, PAIgA and PAIgM, peripheral T cell subpopulations, and B cells of CD19(+)/CD20(+) were detected before and after rituximab therapy.

RESULTSComplete response (CR) was achieved in 6 patients (23.1%), response (R) in 10 (38.5%), and non-response (NR) in 10 (38.5%). One patient relapsed after R. The median follow-up time was 5.5 (0.8 - 8) months. The median response and CR time were 27 (1 - 104) and 41 (4 - 109) days, respectively. After the therapy, the serum concentrations of IgG, IgA, IgM, T cells of CD3(+), CD3(+)CD4(+), CD3(+)CD8(+), CD3(-)CD56(+), CD4(+)CD25(+) and CD4(+)CD25(+)FOXP3(+) were not changed, the number of CD4(+)CD25(+)FOXP3(-) T cells decreased (P < 0.05) and CD19(+)CD20(+) B cells significantly decreased (P < 0.01). PAIgG was lower after treatment compared with that before treatment (P < 0.05). There were no severe adverse effects during rituximab therapy.

CONCLUSIONLower dose rituximab may be an effective and safe modality for patients with ITP.

Anemia, Hemolytic, Autoimmune ; therapy ; Antibodies, Monoclonal, Murine-Derived ; therapeutic use ; Female ; Humans ; Infant ; Rituximab

Monoclonal antibodies (MoAbs) have different mechanism and adverse effects compared with cytotoxic agents. The introduction of MoAbs has improved the treatment potency to malignant lymphoma without decreasing the quality of life. However, there are many questions to be answered: What is the profound mechanism of MoAbs? How about their long-term adverse effects? What is the best medication pattern in different disease types?
Antibodies, Monoclonal ; therapeutic use ; Antibodies, Monoclonal, Murine-Derived ; Antibodies, Neoplasm ; therapeutic use ; Antineoplastic Agents ; therapeutic use ; Drug Delivery Systems ; methods ; Drug Design ; Humans ; Lymphoma ; therapy ; Radioimmunotherapy ; Rituximab

Abatacept ; Antibodies, Monoclonal, Humanized ; therapeutic use ; Antibodies, Monoclonal, Murine-Derived ; therapeutic use ; Biological Therapy ; methods ; Diabetes Mellitus, Type 1 ; drug therapy ; Humans ; Immunoconjugates ; therapeutic use ; Rituximab

Antibodies, Monoclonal, Murine-Derived ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Humans ; Lymphoma, Follicular ; drug therapy ; Rituximab