1.
Eltrombopag versus romiplostim in treatment of children with persistent or chronic immune thrombocytopenia: a systematic review incorporating an indirect-comparison meta-analysis
Zhang J, Liang Y, Ai Y, Li X, Xie J, Li Y, Zheng W, He R.
Scientific Reports. 2018;8((1)):576.
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.
2.
Eltrombopag versus romiplostim in treatment of adult patients with immune thrombocytopenia: A systematic review incorporating an indirect-comparison meta-analysis
Zhang J, Liang Y, Ai Y, Li X, Xie J, Li Y, Zheng W, He R
Plos One. 2018;13((6)):e0198504.
Abstract
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).
3.
Thrombopoietin-receptor agonists for children with immune thrombocytopenia: a systematic review
Li Y, Zhang J, Liang Y, Ai Y, Xie J, Zheng W
Expert Opinion on Pharmacotherapy. 2017;18((15):):1543-1551
Abstract
OBJECTIVE We conducted a systematic review to assess the efficacy and safety of Thrombopoietin-receptor agonists(TPOras) for pediatric immune thrombocytopenia(ITP). METHODS We searched PubMed, Embase and Cochrane Library from their earliest records to January 2017. Randomized controlled trials(RCTs) evaluating the efficacy and safety of TPOras in children were included. Primary outcomes were durable response and clinically significant bleeding. Secondary outcomes were overall response, overall bleeding events, the proportion of patients receiving rescue medication and adverse events(AEs). RESULTS Five randomized RCTs(261participants) were included in this systematic review. Compared with placebo group, the proportion of patients achieving durable platelet response was significantly higher in Eltrombopag(92 participants, P=0.0004) or Romiplostim(62 participants, P=0.002) group, so was the overall response in Eltrombopag[RR=2.64, 95%CI(1.58, 4.44)] or Romiplostim[RR=5.05, 95%CI(2.21, 11.53)] group. Both clinically significant bleeding(159 participants, P=0.04) and total bleeding(183 participants, P=0.01) in Eltrombopag group were significantly less frequent than those in placebo group, while no significant difference between Romiplostim and placebo group. The proportion of patients receiving rescue medication, the incidence of overall AEs and serious AEs between TPO-receptor agonists and placebo group were not significantly different. CONCLUSION TPOras might improve both durable and overall platelet response in pediatric ITP, compared with placebo.