Meta-Analysis on Impact of Rituximab in Patients with Hematological Malignancies with Covid-19 Infection

ABSTRACT:

Background: It is well known that patients with hematological malignancies have worse outcomes with Covid 19 infection when compared with patients with solid malignancies. The impact of rituximab, a commonly used drug for these patients, remains under investigation. Here we present a meta-analysis elucidating the impact of rituximab on mortality rates for patients infected with Covid-19.

Methods:

We thoroughly searched PubMed, Embase, Cochrane, and clinicaltrials.gov for papers reporting Covid 19-infected patients who received rituximab for hematological malignancies. Studies were included if they reported mortality outcomes. Case reports, letters to the editor, review articles, and articles in languages other than English were all excluded. Primary outcomes were all-cause and COVID-19-related in-hospital mortality, and baseline data collected included age, sex, and comorbidities.

Results:

From the 364 studies screened, 4 studies with a population size of 290 were included [Table 1]. Two studies out of the four were included in the final meta-analysis, as the remaining two showed zero events of mortality in the rituximab group. Out of 257 patients included in the analysis, 67 patients received rituximab. Pooled hazard ratio of overall survival in the rituximab group was 0.25 [95% CI; 0.12, 0.51], which means there is significantly decreased overall survival in the rituximab group. Fixed effect model was used for meta-analysis as I2 = 0% and p-value = 0.319 [Figure 1].

Discussion:

The above study highlights that administration of rituximab has significantly increased mortality in patients with hematological malignancy. Evidence-based literature shows that B cell depletion in rituximab-treated patients has increased the risk of prolonged viremia mortality, length of stay, and mechanical ventilation. Limitations of our study are the small sample size and the different methods of reporting mortality and survival.

No relevant conflicts of interest to declare.