title: Rituximab plus standard of care for treatment of primary immune thrombocytopenia: a systematic review and meta-analysis.
abstract: BACKGROUND
  Rituximab is commonly used as a treatment for primary immune thrombocytopenia to induce and maintain remission. The benefit of adding rituximab to standard-of-care treatment is uncertain.
  
  
  METHODS
  We did a systematic review and meta-analysis of randomised controlled trials assessing the efficacy and safety of rituximab for treatment of adults with primary immune thrombocytopenia. We searched Medline, Embase, and the Cochrane database in duplicate and independently from inception up to July 31, 2014, for relevant studies. Primary outcomes were the proportion of patients achieving a complete platelet count response and a partial platelet count response (as defined in primary studies) that was maintained until the end of follow-up. We also assessed bleeding, infection, and infusion reactions.
  
  
  RESULTS
  Our database search returned 468 abstracts, of which five trials (with total of 463 patients) were eligible for analysis. No patients had splenectomy at the time of enrolment. Median follow-up was 6 months (IQR 6-12). Complete response (>100 × 10(9) platelets per L without rescue therapy) was more common with rituximab than with standard of care (weighted proportions: 46·8% vs 32·5%; relative risk [RR] 1·42, 95% CI 1·13-1·77; p=0·0020). Partial response was not significantly different between groups (57·6% vs 46·7%; RR 1·26, 95% CI 0·95-1·67; p=0·11). Rituximab was not associated with a reduction in bleeding (9·2% vs 5·2%; RR 1·34, 95% CI 0·63-2·87; p=0·44) or an increase in infections (20·1% vs 12·1%; RR 1·40, 95% CI 0·87-2·26; p=0·17).
  
  
  CONCLUSIONS
  Rituximab can improve complete platelet count responses by 6 months in patients with immune thrombocytopenia. Evidence for sustained responses beyond 6-12 months is limited. Clinicians must consider the goals of treatment before prescribing rituximab.
  
  
  BACKGROUND
  None.
authors.affiliation: Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Shaan
authors.initials: S
authors.lastname: Chugh
authors.affiliation: Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Saeed
authors.initials: S
authors.lastname: Darvish-Kazem
authors.affiliation: Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Wendy
authors.initials: W
authors.lastname: Lim
authors.affiliation: Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Crowther
authors.affiliation: Østfold Hospital Trust, Fredrikstad, Norway.
authors.forename: Waleed
authors.initials: W
authors.lastname: Ghanima
authors.affiliation: Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Grace
authors.initials: G
authors.lastname: Wang
authors.affiliation: Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Heddle
authors.affiliation: Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: John G
authors.initials: JG
authors.lastname: Kelton
authors.affiliation: Department of Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Canadian Blood Services, Hamilton, ON, Canada. Electronic address: arnold@mcmaster.ca.
authors.forename: Donald M
authors.initials: DM
authors.lastname: Arnold
mesh_terms: D006801:Humans; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D000069283:Rituximab / Q000627:therapeutic use*; D059039:Standard of Care; D016896:Treatment Outcome
chemical_list: D000069283:Rituximab