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Treatment efficacy for adult persistent immune thrombocytopenia: a systematic review and network meta‐analysis
Author(s) -
Puavilai Teeraya,
Thadanipon Kunlawat,
Rattanasiri Sasivimol,
Ingsathit Atiporn,
McEvoy Mark,
Attia John,
Thakkinstian Ammarin
Publication year - 2020
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.16161
Subject(s) - immune thrombocytopenia , meta analysis , medicine , immune system , immunology , hematology , medline , intensive care medicine , platelet , biology , biochemistry
Summary 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.