Comparative efficacy of 19 drug therapies for patients with idiopathic thrombocytopenic purpura: a multiple-treatments network meta-analysis

Department of Hematology and Oncology, The Children's Hospital of Soochow University, No. 92, Zhongnan Street, Suzhou, China. Department of Hematology and Oncology, The Children's Hospital of Soochow University, No. 92, Zhongnan Street, Suzhou, China. hsy139@126.com.

Annals of hematology. 2022
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PICO Summary

Population

People with idiopathic thrombocytopenia purpura (ITP) enrolled in clinical trials, and identified by systematic review (n= 2,615, 19 RCTs).

Intervention

Interventions for ITP: romiplostim, eltrombopag, rituximab, prednisolone, IVIG, efgartimod, dexamethasone or avatrombopag.

Comparison

Placebo, dexamethasone, danazol or other drug interventions.

Outcome

The efficacy of eltrombopag plus rituximab, avatrombopag, dexamethasone plus anti-HP, and dexamethasone plus rhTPO was significantly higher than placebo (odds ratio [OR]: 46.66, 29.44, 2.66, 1.86) or dexamethasone alone (OR: 46.22, 29.01, 2.22, 1.40). Placebo, oral immunosuppressants, and dexamethasone plus oseltamivir were less effective than the other ITP therapies tested.
Abstract
Immune thrombocytopenia (ITP) is the most common clinical bleeding disorder with a high mortality rate and poor long-term survival quality in severe patients. There is controversy on how to choose the appropriate treatment. We systematically reviewed 19 randomized controlled trials (including 2615 participants) from January 1, 2015, to April 20, 2021. These investigations compared multiple drugs or their combinations in the therapeutic dose range for the treatment of ITP. The primary endpoint was based on the proportion of patients who responded to these therapies. The efficacy of eltrombopag plus rituximab, avatrombopag, dexamethasone plus anti-HP, and dexamethasone plus rhTPO was significantly higher than placebo (OR: 46.66, 29.44, 2.66, 1.86) or dexamethasone alone (OR: 46.22, 29.01, 2.22, 1.40). Placebo, oral immunosuppressants, and dexamethasone plus oseltamivir were less effective than the other ITP therapies tested. Eltrombopag plus rituximab may be the best choice when starting treatment for ITP.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine