Efficacy and safety of rituximab in rheumatoid arthritis-associated interstitial lung disease: a systematic review and meta-analysis

To assess the effectiveness and safety of Rituximab (RTX) treatment among patients diagnosed with rheumatoid arthritis-associated interstitial lung disease (RA-ILD). We performed a systematic review with meta-analysis of studies involving patients with RA-ILD who were treated with RTX. Two investigators independently conducted the research. Twenty studies met the criteria for data extraction for the systematic review with a good quality assessment according to an 18-criteria checklist using a modified Delphi method. The total number of patients was 14,523, including 1,619 who received RTX. Stabilization or improvement was observed in more than half of the patients in all studies. Evaluation based on pulmonary function tests (PFTs) noted disease progression in fewer than 20% of 7 out of 11 studies. Meta-analysis results revealed that, based on PFTs, the proportion of patients showing functional decline was 14.5% (95%CI, 7.6–25.8%) (95%PI, 2–69%); and according to the pulmonary high-resolution computed tomography (HRCT) evaluation, the proportion of worsening was 19.5% (95%CI, 8.1–40%) (95%PI, 1–84%). An overall acceptable safety profile was noted, with respiratory mortality ranging from 4% to 14%. Our review suggests that RTX appears to be an effective therapy in patients with RA-ILD, with a satisfactory safety profile. https://www.crd.york.ac.uk/prospero identifier is CRD420251049957.