Eficacia del sutimlimab y rituximab en el tratamiento de la anemia hemolítica autoinmune: revisión sistemática

Abstract

Autoimmune hemolytic anemia (AIHA) is a hematologic disorder caused by the activation of autoantibodies that lead to the lysis of red blood cells. It is classified according to the antibody involved (IgG, IgM), its activation temperature (cold, warm), and its origin (primary, secondary). AIHA caused by warm autoantibodies accounts for approximately 80% of cases worldwide. Currently, monoclonal antibodies such as sutimlimab and rituximab offer a promising alternative for the treatment of the disease. General Objective: To determine the efficacy of sutimlimab and rituximab in the treatment of autoimmune hemolytic anemia. Specific Objectives: To establish an updated bibliographic basis on autoimmune hemolytic anemia and the efficacy of sutimlimab and rituximab in its treatment, in order to update knowledge on the management of AIHA. Methods: A systematic review was conducted following the PRISMA methodology, focused on obtaining, organizing, and describing updated information on the efficacy of rituximab and sutimlimab in the treatment of AIHA. Bias: The RoB 2 tool was used. Level of Evidence: Evaluated using the Oxford and NHLBI tools. Results: Sutimlimab and rituximab (as monotherapy or in combination) achieved hemoglobin increases of 2.6 to 4 g/dL, reductions in lactate dehydrogenase (LDH) of up to 60%, and a significant decrease in transfusion requirements (up to 100%). Response rates ranged from 54% to 93%, with sustained clinical improvements and response times ranging from 3 to 6 weeks. Controlled trials, such as CADENZA, CARDINAL, RAIHA, and Waldenström provided stronger evidence, while open-label studies confirmed efficacy results, although with methodological limitations. Keywords: autoimmune hemolytic anemia, immunoglobulins, monoclonal antibody sutimlimab, rituximab