Meta-analysis of rituximab treatment of systemic sclerosis related interstitial lung disease

<bold>Background:</bold> ILD is now the leading cause of mortality in systemic sclerosis (SSc) with a 10-year mortality of 40%. Clinical trials with cyclophosphamide (CYC), mycophenolic acid and tocilizumab in SSc-ILD have all shown a degree of efficacy but there are no well powered RCTs for rituximab (RTX) treatment of SSc-ILD. <bold>Methods:</bold> A comprehensive search strategy using PubMed, Embase and the Cochrane Library was conducted to identify studies of RTX treatment of SSc-ILD. The suitability of 46 studies were reviewed. Only trials with both CT evidence of ILD and a mean baseline FVC of less than 80% predicted were included. Cochrane’s RevMan software was used to produce the forest plots. <bold>Results:</bold> 17 studies were included for analysis; 4 RCTs, 5 prospective, and 8 retrospective. Meta-analysis of 7 studies produced a forest plot suggesting an improvement in FVC at 6 months. Similarly, the inclusion of 12 studies produced a forest plot demonstrating similar improvement in FVC at 12 months. 3 RCTs comparing RTX and CYC were also analysed. The forest plot produced suggests a greater beneficial effect with RTX on FVC at 6 months. <fig><object-id>erj;64/suppl_68/PA694/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig> <bold>Conclusion:</bold> This meta-analysis suggests that RTX treatment of SSc-ILD results in improved lung function rather than just stabilisation. The forest plot of the 3 RCTs comparing RTX and CYC is in favour of RTX. These results are reassuring and suggest RTX may be opted for particularly if CYC toxicity is a concern.