Publication: Treatment efficacy for adult persistent immune thrombocytopenia: a systematic review and network meta-analysis
Issued Date
2019-01-01
Resource Type
ISSN
13652141
00071048
00071048
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2-s2.0-85070802922
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Mahidol University
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SCOPUS
Bibliographic Citation
British Journal of Haematology. (2019)
Suggested Citation
Teeraya Puavilai, Kunlawat Thadanipon, Sasivimol Rattanasiri, Atiporn Ingsathit, Mark McEvoy, John Attia, Ammarin Thakkinstian Treatment efficacy for adult persistent immune thrombocytopenia: a systematic review and network meta-analysis. British Journal of Haematology. (2019). doi:10.1111/bjh.16161 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/52343
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Title
Treatment efficacy for adult persistent immune thrombocytopenia: a systematic review and network meta-analysis
Abstract
© 2019 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd Persistent immune thrombocytopenia (ITP) patients require second-line treatments, for which information on clinical outcomes are lacking. A systematic review and network meta-analysis (NMA) were conducted. Only randomised controlled trials (RCT) of second-line drugs in adult persistent ITP patients with platelet response, platelet count, any bleeding or serious adverse events (SAE) outcome were eligible. Twelve RCTs (n = 1313) were included in NMA. For platelet response outcome, eltrombopag and romiplostin were the best relative to placebo; the former had a non-significant advantage [risk ratio (RR) = 1·10 (95% confidence interval: 0·46, 2·67)]. Both treatments were superior to rituximab and recombinant human thrombopoietin (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 highest, followed by eltrombopag, rhTPO+rituximab, and rituximab. For bleeding, 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 had the best balance between short-term efficacy and SAEs, followed by eltrombopag. In conclusion, romiplostim and eltrombopag may yield high efficacy and safety. Rituximab may not be beneficial due to lower efficacy and higher complications compared with the thrombopoietin receptor agonists. RCTs with long-term clinical outcomes are required.