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Eltrombopag versus romiplostim in treatment of children with persistent or chronic immune thrombocytopenia: a systematic review incorporating an indirect-comparison meta-analysis

Chinese Evidence-based Medicine Center, Sichuan University, Chengdu, China. Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China. Health Outcomes and Pharmacy Practice, College of Pharmacy, the University of Texas at Austin, Texas, United States. Department of Pediatric Hematology and Oncology, West China Second University Hospital, Sichuan University, Chengdu, China. Department of Pharmacy, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, China. Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China. Chinese Evidence-based Medicine Center, Sichuan University, Chengdu, China. yzmylab@hotmail.com. Experimental Cancer Medicine, Clinical Research Center, Department of Laboratory Medicine, Karolinska Institute, Huddinge, 14186, Stockholm, Sweden. Experimental Cancer Medicine, Clinical Research Center, Department of Laboratory Medicine, Karolinska Institute, Huddinge, 14186, Stockholm, Sweden.

Scientific Reports. 2018;8((1)):576.
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Abstract
In absence of direct comparison, we conducted an indirect-comparison meta-analysis to evaluate the efficacy and safety of thrombopoietin-receptor agonists(TPO-RAs) in treatment of pediatric persistent or chronic immune thrombocytopenia(ITP). PubMed, Embase, Cochrane Library, Clinical Trials.gov, China National Knowledge Infrastructure, and Chinese Biomedical Literature Database were searched from their earliest records to May 2017. Randomized controlled trials comparing the TPO-RAs with placebo in pediatric ITP were included. Outcomes included overall response rate(primary), durable response, overall or clinically significant bleeding, the proportion of patients receiving rescue medication, and safety. Five randomized placebo-controlled studies(N = 261) were analyzed. The overall response[Risk Ratio(RR) 0.57, 95% confidence interval(CI) 0.21-1.56], the incidence of adverse events (RR 0.96, 95%CI 0.66-1.39), durable response(RR 2.48, 95%CI 0.31-19.97), and the proportion of patients receiving rescue treatment(RR 0.73, 95%CI 0.20-2.73) were similar between eltrombopag and romiplostim group. Nevertheless, eltrombopag might have lower risk of overall bleeding(RR 0.43, 95%CI 0.23-0.80) and clinically significant bleeding(RR 0.33, 95%CI 0.12-0.89) than romiplostim. This meta-analysis suggests that eltrombopag might be similar to romiplostim in efficacy and safety, but seems to reduce the risk of bleeding compared to romiplostim. Furthermore, cost of the treatment, comorbidity of patients and drug compliance should also be considered in clinical decision making.
Study details
Study Design : Systematic Review
Language : English
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine