Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies. [cochranelibrary.com]

• Fatigue

  […] corticosteroid (%) Corticosteroid only (%) P value Fever 3.3 6.7 0.6 Nausea 0 10 0.1 Dyspnea 13.3 16.7 0.7 Dyspepsia 3.3 13.3 0.2 Restless legs 6.7 0 0.5 Vertigo 0 10 0.1 Increased appetite 0 10 0.1 Insomnia 10 10 1.0 Arthralgia 6.7 3.3 1.0 Headache 6.7 13.3 0.4 Fatigue [cochranelibrary.com]

• Splenectomy

  Splenectomy has been considered the second‐line therapy for people failing glucocorticoid therapy. [cochranelibrary.com]

• Nausea

  Nausea, vomiting, alopecia, myelosuppression, haemorrhagic cystitis, and gonadal toxicity are potential adverse effects with the drug. [cochranelibrary.com]

• Jaundice

  Haemolysis on the other hand, is suggested clinically when yellowish discolouration of the skin (jaundice), together with pallor is detected, with or without the presence of enlargement of the spleen (splenomegaly). [cochranelibrary.com]

• Headache

  Rituximab+corticosteroid (%) Corticosteroid only (%) P value Fever 3.3 6.7 0.6 Nausea 0 10 0.1 Dyspnea 13.3 16.7 0.7 Dyspepsia 3.3 13.3 0.2 Restless legs 6.7 0 0.5 Vertigo 0 10 0.1 Increased appetite 0 10 0.1 Insomnia 10 10 1.0 Arthralgia 6.7 3.3 1.0 Headache [cochranelibrary.com]

We excluded trials of supportive treatment such as folic acid supplement and transfusion alone. The control interventions could be another specific treatment,supportive treatment alone, placebo treatment, or no treatment. [cochranelibrary.com]

Subgroup analysis and investigation of heterogeneity We planned to perform subgroup analyses (Deeks 2011) for the following subgroups as they may have different prognosis and response to treatment (different size of treatment effect). [cochranelibrary.com]

Studies should also target various populations based on patient age and differences in disease pathophysiology. Studies with adequate follow‐up, report on survival and quality of life (QOL) measures should be prioritised in such chronic conditions. [cochranelibrary.com]