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All Journal Paediatrica Indonesiana Medicinus : Jurnal Kedokteran
Heriawan, Timotius Ivan
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Health Professions Medicine & Pharmacology Public Health

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Efficacy and safety of rituximab in children with steroid- and calcineurin inhibitor-dependent nephrotic syndrome: a systematic review of randomized controlled trials Sharon, Sharon; Nadhifah, Nadhifah; Heriawan, Timotius Ivan; Rahmatika, Nadya; Zahara, Nadia Eva; Purnomo, Athaya Febriantyo; Lazarus, Gilbert
Paediatrica Indonesiana Vol. 64 No. 6 (2024): November 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.6.2024.490-500

Abstract

Background Efficacy of rituximab in the management of idiopathic nephrotic syndrome in children is well-established, however there is limited evidence of its efficacy in children with steroid- and calcineurin inhibitor-dependent nephrotic syndrome (CNI-SDNS). Objective To investigate the efficacy and safety of rituximab in children with CNI-SDNS. Methods We conducted a comprehensive search for relevant RCTs in PubMed, Scopus, Cochrane Central Register of Controlled Trials, and Google Scholar. Eligible RCTs were included, assessed for risk of bias using the Revised Cochrane risk-of-bias tool for randomized trials, and summarized narratively. Results A total of five RCTs (299 children) were included in the review. Rituximab was effective in maintaining remission and preventing relapse in pediatric CNI-SDNS patients, in a manner potentially superior to conventional therapy. Furthermore, rituximab successfully resulted in a higher rate of steroid and CNI withdrawal, along with prolonged drug-free period. However, the benefits of rituximab in children with focal segmental glomerulosclerosis (FSGS) remains equivocal. The drug was generally well-tolerated, both in the short-term and long-term, with a low incidence of adverse events and infusion reactions, typically of mild and reversible nature. Conclusion Rituximab appears to be effective and safe in treating children with CNI-SDNS, offering potential benefits in reducing dependence on steroids and CNIs. Larger trials comparing the effectiveness of rituximab specifically between children with minimal change disease (MCD) and FSGS are warranted to further validate and strengthen our findings.
Vaccine-Based Immunotherapy for Metastatic Colorectal Cancer: A Systematic Review Amelia, Sesa; Mathlubaa, Asya; Amly, Harzalina Zilfi; Jacobs, Christin Yosefin; Halim, Kurnia; Heriawan, Timotius Ivan; Guantoro, Vincent; Putri, Hesti Andika
Medicinus Vol. 14 No. 3 (2025): June
Publisher : Fakultas Kedokteran Universitas Pelita Harapan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19166/med.v14i3.10166

Abstract

Background: Metastatic colorectal cancer (mCRC) remains a therapeutic challenge, particularly in microsatellite stable (MSS) tumors, which are largely unresponsive to current immunotherapy approaches. Vaccine-based immunotherapy offers a strategy to elicit tumor-specific immune responses in these immunologically “cold” tumors. However, clinical results have been mixed, and the efficacy and safety of cancer vaccines in mCRC remain to be clarified. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. Randomized controlled trials (RCTs) evaluating vaccine-based immunotherapy in mCRC were identified from PubMed, EMBASE, and Scopus as of May 2, 2025. Eligible studies included human subjects with mCRC receiving vaccine therapy with or without additional treatments, compared to standard or placebo regimens. The primary outcomes were overall survival (OS) and progression-free survival (PFS); safety was assessed by the incidence of grade ≥3 treatment-related adverse events. Result: Five RCTs comprising 804 patients met inclusion criteria. Pooled analysis showed a trend toward improved OS with vaccine-based immunotherapy (HR 0.81; 95% CI, 0.65–1.00; p = 0.05; I² = 0%), and a modest, non-significant improvement in PFS (HR 0.80; 95% CI, 0.62–1.05; p = 0.07; I² = 0%). The incidence of severe adverse events was lower with vaccine-based therapies (RR 0.31; 95% CI, 0.02–6.09; p = 0.23; I² = 90%). Conclusions: Vaccine-based immunotherapy in mCRC demonstrates potential clinical benefit, particularly in prolonging survival with a favorable safety profile. Further biomarker-driven studies are needed to optimize patient selection and therapeutic combinations.
Co-Authors Amelia, Sesa Amly, Harzalina Zilfi Guantoro, Vincent Halim, Kurnia Jacobs, Christin Yosefin Lazarus, Gilbert Mathlubaa, Asya Nadhifah, Nadhifah Purnomo, Athaya Febriantyo Putri, Hesti Andika Rahmatika, Nadya Sharon, Sharon Zahara, Nadia Eva