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The following is a summary of “Rituximab combined with intravenous immunoglobulin in autoimmune diseases: a systematic review,” published in the March 2025 issue of Advances in Rheumatology by Carvalho et al. 

The use of Rituximab (RTX) and intravenous immunoglobulin (IVIg) in combination had been uncommon and insufficiently investigated, despite their established roles as separate therapies for autoimmune diseases. 

Researchers conducted a retrospective study to examine the combined use of RTX and IVIg in autoimmune conditions. 

They reviewed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, screening PubMed/MEDLINE, Scielo, and EMBASE databases for studies published until May 2024 without language restrictions and applied the MeSH terms “Intravenous immunoglobulin” AND “rituximab” AND “autoimmune” to enhance sensitivity and specificity. Inclusion criteria involved adults (age ≥ 18 years) that evaluated RTX with IVIg for autoimmune diseases.  

The results showed that 21 studies assessed RTX combined with IVIg in autoimmune diseases, 10 studies included 85 individuals with pemphigus subtypes (47 pemphigus vulgaris, 27 pemphigoids, 11 other variants), mostly from case reports or case series, with 1 retrospective study including controls. All but 1 case of paraneoplastic pemphigus showed positive outcomes. Infections, including P jirovecii pneumonia, were reported in 3 studies. The remaining 11 studies involved 24 individuals with polyneuropathies, central nervous system lupus, and neuromyelitis optica. Most findings were favorable, although 1 study reported no reduction in IVIg dependency with RTX in IVIg-dependent polyneuropathies. Reported adverse events (AEs) included pneumonia, venous thrombosis with pulmonary embolism, and infusion-related reactions, indicating the importance of clinical monitoring. 

Investigators concluded that RTX plus IVIg appeared to be an alternative option for the treatment of refractory autoimmune diseases, but that more studies with a larger number of participants and in different autoimmune diseases were desired. 

Source: advancesinrheumatology.biomedcentral.com/articles/10.1186/s42358-025-00450-x