Background/Purpose: Rituximab targets the CD20 antigen to deplete B cells and is indicated for a number of autoimmune diseases and other conditions. Accumulating data suggest that treatment with anti-CD20 therapy may put patients at an increased risk of worse outcomes from COVID-19. However, the exact effects of Rituximab on the outcomes of COVID-19 infection are still controversial. Thus, this meta-analysis was conducted to explore the effects of Rituximab on COVID-19 outcomes.

Methods: The literature searching was completed before June 6, 2022 for relevant available articles from the PubMed. Statistical analyses of all data were performed with RevMan (version 5.4; Cochrane library) software. Odds ratios (ORs) with 95% confidence intervals (CI) were pooled through either fixed-effect or random-effect model, depending on the heterogeneity which was evaluated through the Q test and I-squared statistic. Publication bias assessment were also conducted when more than three original studies were included for pooled-analysis.

Results: Eight studies were included. Rituximab was associated with an increased risk of progression to more severe disease, with a pooled OR of 3.37 (95% CI = 2.01-5.65, I² =0%). The use of Rituximab also correlated with increased risks of hospitalization (OR: 2.58, 95% CI = 1.42-4.70, I² =72%) and admission to intensive care unit (ICU) (OR: 2.70, 95% CI = 1.72-4.25, I² =0%), but its use was not associated with risk of mechanical ventilation (OR: 1.67, 95% CI = 0.74-3.76, I² =74%). Five records from four enrolled articles revealed an increased risk of death in patients taking Rituximab, with a pooled OR of 2.33 (95% CI = 1.83-2.96, I² =0%). The funnel plot of the outcome of death appeared to be symmetrical, suggesting a low likelihood of publication bias.

Conclusion: In COVID-19 patients, Rituximab is associated with increased risks of severe disease, hospitalization, ICU admission, and death in COVID-19 patients, but it does not correlate with ventilation risk. However, more databases need to be searched to assure no eligible original studies are missing. More subgroup analyses, such as indications of Rituximab, different genders, age groups, and ethnicities, are still needed to stratify the risk more precisely in different populations.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/is-rituximab-associated-with-worse-outcomes-in-covid-19-patients-a-meta-analysis/