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Efficacy of therapeutic plasma exchange for treatment of autoimmune hemolytic anemia: A systematic review and meta‐analysis of randomized controlled trials
Author(s) -
Deng Jiawen,
Zhou Fangwen,
Wong Chi Yi,
Huang Emma,
Zheng Elena
Publication year - 2020
Publication title -
journal of clinical apheresis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.697
H-Index - 46
eISSN - 1098-1101
pISSN - 0733-2459
DOI - 10.1002/jca.21790
Subject(s) - medicine , incidence (geometry) , autoimmune hemolytic anemia , hematocrit , subgroup analysis , anemia , relative risk , randomized controlled trial , adverse effect , publication bias , confidence interval , meta analysis , number needed to treat , gastroenterology , physics , optics
Objective We performed a systematic review and meta‐analysis to evaluate the efficacy and safety of therapeutic plasma exchange (TPE) in adult patients with autoimmune hemolytic anemia (AIHA). Methods A search of major English and Chinese databases for randomized controlled trials (RCTs) comparing the use of TPE against no TPE in adult AIHA patients was performed. Outcomes were remission incidence, hematological parameters (ie, hemoglobin count, red blood cell count, reticulocyte percentage, total bilirubin, and hematocrit) and adverse event incidence. Results Thirteen RCTs containing 906 patients were included. A majority of RCTs were given an unclear risk of bias. TPE was associated with increased remission incidence (risk ratio [RR] = 1.22, 95% confidence interval [CI] = 1.15‐1.30) and improved hematological parameters. TPE was also associated with an insignificant increase in adverse event incidence (RR = 1.12, 95% CI = 0.68 to 1.86). Publication bias was detected for remission incidence and reticulocyte percentage, and it may have led to an overestimation of beneficial improvements in reticulocyte percentage. Conclusion TPE was associated with both increased remission incidence and improved hematological parameters. It is capable of improving short‐term hematological parameters to stabilize acute AIHA onset. Our results should be interpreted with caution due to the unclear risk of bias and the presence of publication biases. We were not able to determine the treatment effects for cold and warm AIHA separately due to a lack of subgroup data. Future RCTs incorporating larger sample sizes with subgroup data for warm and cold AIHA are needed to validate our findings and establish subgroup efficacy and safety.