- Title
- Treatment efficacy for adult persistent immune thrombocytopenia: a systematic review and network meta-analysis
- Creator
- Puavilai, Teeraya; Thadanipon, Kunlawat; Rattanasiri, Sasivimol; Ingsathit, Atiporn; McEvoy, Mark; Attia, John; Thakkinstian, Ammarin
- Relation
- British Journal of Haematology Vol. 188, Issue 3, p. 450-459
- Publisher Link
- http://dx.doi.org/10.1111/bjh.16161
- Publisher
- Wiley-Blackwell
- Resource Type
- journal article
- Date
- 2020
- Description
- Persistent immune thrombocytopenia (ITP) patients require second-linetreatments, for which information on clinical outcomes are lacking. A sys-tematic review and network meta-analysis (NMA) were conducted. Onlyrandomised controlled trials (RCT) of second-line drugs in adult persistentITP patients with platelet response, platelet count, any bleeding or seriousadverse events (SAE) outcome were eligible. Twelve RCTs (n=1313) wereincluded in NMA. For platelet response outcome, eltrombopag and romi-plostin were the best relative to placebo; the former had a non-significantadvantage [risk ratio (RR)=1 10 (95% confidence interval: 0 46, 2 67)].Both treatments were superior to rituximab and recombinant humanthrombopoietin (rhTPO)+rituximab, with corresponding RRs of 4 56 (1 89,10 96) and 4 18 (1 21, 14 49) for eltrombopag; 4 13 (1 56, 10 94) and 3 79(1 02, 14 09) for romiplostim. For platelet count, romiplostim ranked high-est, followed by eltrombopag, rhTPO+rituximab, and rituximab. For bleed-ing, rituximab had lowest risk, followed by eltrombopag and romiplostim.For SAEs, rhTPO+rituximab had highest risk, followed by rituximab,eltrombopag and romiplostim. From clustered ranking, romiplostim hadthe best balance between short-term efficacy and SAEs, followed by eltrom-bopag. In conclusion, romiplostim and eltrombopag may yield high efficacyand safety. Rituximab may not be beneficial due to lower efficacy andhigher complications compared with the thrombopoietin receptor agonists.RCTs with long-term clinical outcomes are required.
- Subject
- monoclonal antibodies; immunosuppressive agents; persistent immune thrombocytopenia; thrombopoietin receptor agonists; network meta-analysis; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1469742
- Identifier
- uon:48300
- Identifier
- ISSN:0007-1048
- Rights
- © 2019 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
- Language
- eng
- Full Text
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