Rituximab as Rescue or Add-On Therapy for Relapsing or Refractory Lupus Nephritis: A Systematic Review and Meta-Analysis
In brief
Rituximab-based therapy produced kidney responses in about 7 in 10 patients
Across 19 studies involving 445 patients with relapsing or refractory lupus nephritis, about 7 in 10 had an overall renal response at 6 to 12 months; about 4 in 10 achieved complete response at 12 months. Proteinuria and creatinine also decreased, but the studies do not show how rituximab compares with other treatments, so its role remains uncertain.
- Journal
- Clinical and translational science (Q1)
- Published
- 1 October 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Xiaolong Wang, Shuang Liang, Xiaowei Sun, Fuling Wang, Guichun Tang, Weizhu Deng, et al.
- PMID
- 42806593
- DOI
- 10.1111/cts.70730
Why clinicians should know about it
- Picked for Rheumatology (paper of the day, 1 October 2026): Meta‑analysis of rituximab rescue therapy in refractory lupus nephritis
Abstract
Relapsing and refractory lupus nephritis (LN) remains difficult to manage despite advances in immunosuppressive and targeted therapies. Rituximab (RTX) is often used as rescue or add-on therapy, but renal outcomes in this specific setting have not been quantitatively synthesized. PubMed, Embase, and Web of Science were searched from inception to March 30, 2026. Studies of RTX-based therapy in relapsing or refractory LN were included if renal outcomes were reported. Primary outcomes were complete renal response (CRR), partial renal response (PRR), and overall renal response (ORR) at 6, 12, and 24 months; secondary outcomes were changes in proteinuria and serum creatinine. Random-effects models were used. Nineteen studies involving 445 patients were included. Pooled CRR rates were 0.33 (95% CI 0.21-0.46), 0.41 (95% CI 0.28-0.54), and 0.42 (95% CI 0.26-0.60) at 6, 12, and 24 months, respectively. Corresponding PRR rates were 0.29 (95% CI 0.16-0.45), 0.23 (95% CI 0.07-0.46), and 0.19 (95% CI 0.07-0.34), and ORR rates were 0.67 (95% CI 0.52-0.80), 0.70 (95% CI 0.51-0.86), and 0.66 (95% CI 0.43-0.86). Proteinuria decreased by -2.69 g/day-equivalent (95% CI -3.23 to -2.16), and serum creatinine decreased by -11.79 μmol/L (95% CI -19.86 to -3.72). Sensitivity analyses were generally stable, and Egger's test detected no significant publication bias. In conclusion, RTX-based rescue or add-on therapy was associated with moderate renal response rates and reductions in proteinuria and serum creatinine in this difficult-to-treat population. Further prospective comparative studies are needed to define its role.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.