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Purpose  In absence of direct comparison randomized controlled trials (RCTs), indirect comparison was conducted to evaluate the efficacy and safety of thrombopoietin-receptor agonists (TPO-RAs) in treatment of adult immune thrombocytopenia (ITP).    Methods  We searched PubMed, Embase and Cochrane Library, Clinical Trials.gov, China National Knowledge Infrastructure, and Chinese Biomedical Literature Database from their earliest records to May 2017. RCTs comparing the TPO-RAs with placebo in adult ITP were included. Primary outcomes were the overall response rate. Secondary outcomes included safety, durable response, overall or clinically significant bleeding, and the proportion of patients receiving rescue medication.    Results  Nine randomized placebo-controlled trials (786 participants) were included in this systematic review. Overall response [ Risk Ratio(RR)  = 0.59, 95% Confidence Interval(CI) : 0.24–1.45], the incidence of adverse events ( RR  = 0.98, 95% CI : 0.79–1.21), durable response ( RR  = 0.47, 95% CI : 0.08–2.81), the incidence of overall bleeding ( RR =  1.15, 95% CI : 0.52–2.57) and clinically significant bleeding ( RR =  1.09, 95% CI : 0.37–3.24), and the proportion of patients receiving rescue treatment ( RR  = 0.95, 95% CI : 0.47–1.90) were similar between eltrombopag and romiplostim.    Conclusions  Eltrombopag and romiplostim might be  equivalent  in efficacy and safety for adult ITP, however, physicians should still take into account drug cost and comorbidities of the specific patient while making decisions on the treatment of ITP with TPO-RAs.    Registration  PROSPERO International Prospective Register of Systematic Review (PROSPERO 2017:  CRD42017068661 ).

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Eltrombopag versus romiplostim in treatment of adult patients with immune thrombocytopenia: A systematic review incorporating an indirect-comparison meta-analysis