The Analysis Study of Effectiveness and Safety of Rituximab in The Management of Pediatric Systemic Lupus Erythematosus: A Systematic Review
Keywords:
rituximab, systemic lupus erythematosus, pediatric, efficacy, safetyAbstract
Background: Pediatric systemic lupus erythematosus (pSLE) is a chronic autoimmune disease with an incidence of 0.3–0.9 per 100,000 children per year. Despite growing interest in RTX as a therapeutic option, its use in pSLE remains off-label, and its efficacy and safety have not been well established in this population. This systematic review aims to assess the effectiveness and safety of RTX in children with pSLE based on literatures of the last decade. Methods: The study followed PRISMA 2020 guidelines, reviewing English-language publications from 2015 to 2025. Editorials, duplicate reviews from the same journal, and papers lacking a DOI were excluded. The literature search was conducted using PubMed, SagePub, SpringerLink, and Google Scholar. Result: A total of 2,172 articles were initially identified through online databases (PubMed, SagePub, SpringerLink, and Google Scholar). After three rounds of screening, eight relevant studies were selected for full-text analysis. Conclusion: Rituximab is an effective and well-tolerated treatment for pediatric SLE, reducing disease activity, corticosteroid dependence, and flare-ups. While generally safe, monitoring for infusion reactions and hypogammaglobulinemia is crucial. Early administration may improve outcomes, highlighting its role in refractory pediatric SLE management.
References
Mahmoud I, Jellouli M, Boukhris I, et al. Efficacy and safety of rituximab in the management of pediatric systemic lupus erythematosus: a systematic review. J Pediatr. 2017;187:213-219.
Basu B, Roy B, Babu BG. Efficacy and safety of rituximab in comparison with common induction therapies in pediatric active lupus nephritis. Pediatr Nephrol. 2017;32(6):1013-1021. doi:10.1007/s00467-017-3583-x
Wu S, Wang Y, Zhang J, et al. Efficacy and safety of rituximab for systemic lupus erythematosus treatment: a meta-analysis. Afr Health Sci. 2020;20(2):871-884.
Zhong Z, Li H, Zhong H, Zhou T. Clinical efficacy and safety of rituximab in lupus nephritis. Drug Des Devel Ther. 2019;Volume 13:845-856. doi:10.2147/DDDT.S195113
Elshaer R, Jaber S, Odeh N, Arbili L, Al-Mayouf SM. Safety and efficacy of biologics in childhood systemic lupus erythematosus: a critical systematic review. Clin Rheumatol. 2024;43(3):863-877. doi:10.1007/s10067-023-06833-z
Thakral A, Klein-Gitelman MS. An Update on Treatment and Management of Pediatric Systemic Lupus Erythematosus. Rheumatol Ther. 2016;3(2):209-219. doi:10.1007/s40744-016-0044-0
Peterknecht E, Keasey MP, Beresford MW. The effectiveness and safety of biological therapeutics in juvenile-onset systemic lupus erythematosus (JSLE): a systematic review. Lupus. 2018;27(13):2135-2145. doi:10.1177/0961203318804879
McCarthy EM, Sutton E, Nesbit S, et al. Short-term efficacy and safety of rituximab therapy in refractory systemic lupus erythematosus: results from the British Isles Lupus Assessment Group Biologics Register. Rheumatology. 2018;57(3):470-479.
Sawhney S, Agarwal M. Rituximab use in pediatric systemic lupus erythematosus: Indications, efficacy and safety in an Indian cohort. Lupus. 2021;30(11):1829-1836. doi:10.1177/09612033211034567
Tambralli A, Beukelman T, Cron RQ, Stoll ML. Safety and efficacy of rituximab in childhood-onset systemic lupus erythematosus and other rheumatic diseases. J Rheumatol. 2015;42(3):541-546.
Watson L, Beresford MW, Maynes C, et al. The indications, efficacy and adverse events of rituximab in a large cohort of patients with juvenile-onset SLE. Lupus. 2015;24(1):10-17. doi:10.1177/0961203314547793
Alexeeva EI, Denisova RV, Valieva SI, et al. Efficacy and safety of rituximab in children with systemic lupus erythematosus: results of a retrospective study of the case series. Curr Pediatr. 2016;15(5):497-504.
Alsubaie MA, Bahkali AB, Alhudaifi SA, et al. The indications and safety of rituximab for the treatment of pediatric autoimmune diseases: a single-center retrospective study. Transl Pediatr. 2024;13(10):1696.
Lin TW, Lin YT, Hu YC, Yu HH, Chiang BL. Rituximab as an effective add-on maintenance therapy for disease activities in childhood-onset systemic lupus erythematosus. Lupus Sci Med. 2024;11(1):e000987.
Ko YJ, Shim YK, Kim WJ, et al. The Efficacy and Safety of Rituximab for the Treatment of Pediatric Autoimmune Neuroinflammatory Disorders at a Single Center. Ann Child Neurol. 2020;28(1):30-36. doi:10.26815/acn.2019.00290
Olfat M, Silverman ED, Levy DM. Rituximab therapy has a rapid and durable response for refractory cytopenia in childhood-onset systemic lupus erythematosus. Lupus. 2015;24(9):966-972. doi:10.1177/0961203315578764
Kaegi C, Wuest B, Schreiner J, et al. Systematic review of safety and efficacy of rituximab in treating immune-mediated disorders. Front Immunol. 2019;10:1990.
Iwata S, Saito K, Hirata S, et al. Efficacy and safety of anti-CD20 antibody rituximab for patients with refractory systemic lupus erythematosus. Lupus. 2018;27(5):802-811. doi:10.1177/0961203317749047
Zhao Z, Liao G, Li Y, Zhou S, Zou H. The efficacy and safety of rituximab in treating childhood refractory nephrotic syndrome: a meta-analysis. Sci Rep. 2015;5(1):8219.
Damato V, Evoli A, Iorio R. Efficacy and safety of rituximab therapy in neuromyelitis optica spectrum disorders: a systematic review and meta-analysis. JAMA Neurol. 2016;73(11):1342-1348.
Trindade VC, Carneiro-Sampaio M, Bonfa E, Silva CA. An Update on the Management of Childhood-Onset Systemic Lupus Erythematosus. Pediatr Drugs. 2021;23(4):331-347. doi:10.1007/s40272-021-00457-z
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Copyright (c) 2025 Muhammad Ilham Wira Tri Putra, Asra Dewita Namora Harahap (Author)
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