Abstract
INTRODUCTION: A primary goal of this study was to systematically assess the efficacy of rituximab (RTX) in treating cryoglobulinemic vasculitis (CV). METHODS: A prospectively registered meta-analysis was conducted to examine eligible randomized controlled trials (RCTs) or cohort studies through searches across PubMed, Embase, Cochrane Library, and Web of Science, with a search period up to February 12, 2025. Data analysis was conducted utilizing STATA 16.0. RESULTS: Incorporating data from 12 studies involving 287 patients, CV patients who received RTX therapy demonstrated notable complete clinical response outcomes (Rate = 0.67, 95% confidence interval (95%CI): 0.61, 0.73) and a good clinical response rate. In addition, patients showed significant relief in symptoms such as skin purpura and skin ulcer (Rate = 0.92, 95%CI: 0.86,0.98). The meta-analysis findings indicated a notable enhancement in serum C4 levels in CV patients following treatment (mean difference (MD) = 0.06, 95%CI: 0.04, 0.07), both at 6-month (MD = 0.07, 95%CI: 0.05, 0.09) and 12-month (MD = 0.07, 95%CI: 0.03, 0.11) follow-ups. These findings suggest a gradual improvement in the underlying condition. The levels of IgM were significantly reduced following treatment (MD = -0.48, 95%CI: -0.65, -0.31), both at 6-month (MD = -1.05, 95%CI: -1.57, -0.52) and 12-month (MD = -0.59, 95%CI:-0.80, -0.38) follow-ups. The levels of cryoglobulin were also decreased following treatment (MD = -0.53, 95%CI: -0.80, -0.26), both at 6-month (MD = -0.67, 95%CI: -0.99, -0.35) and 12-month (MD = -0.67, 95%CI: -1.15, -0.19) follow-ups. Similarly, rheumatoid factor (RF) levels significantly decreased after treatment (MD = -318.20,95%CI:-364.66,-271.73) and remained low at the 6-month follow-up (MD = -287.78, 95%CI:-511.58,-63.97). DISCUSSION: The meta-analysis supports the favorable clinical efficacy of rituximab in the management of CV patients. However, further validation through additional high-quality RCTs is warranted to solidify its effectiveness. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024565790.