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Wang Y, Sheng L, Han F, Guo Q, Zhang Z, Hou Y, Feng Q, Zhou H, Ji X, Peng J, Hou M, Xu M. Efficacy and safety of treatments in newly diagnosed adult primary immune thrombocytopenia: A systematic review and network meta-analysis. EClinicalMedicine 2023; 56:101777. [PMID: 36578882 PMCID: PMC9791309 DOI: 10.1016/j.eclinm.2022.101777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Immune thrombocytopenia is an autoimmune disease characterised by decreased platelet count. In recent years, novel therapeutic regimens have been investigated in randomised controlled trials (RCTs). We aimed to compare the efficacy and safety of different treatments in newly diagnosed adult primary immune thrombocytopenia. METHODS We did a systematic review and network meta-analysis of RCTs involving treatments for newly diagnosed primary immune thrombocytopenia. PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched up to April 31, 2022. The primary outcomes were 6-month sustained response and early response. Secondary outcome was grade 3 or higher adverse events. This study is registered with PROSPERO (CRD42022296179). FINDINGS Eighteen RCTs (n = 1944) were included in this study. Pairwise meta-analysis showed that the percentage of patients achieving early response was higher in the dexamethasone-containing doublet group than in the dexamethasone group (79.7% vs 68.7%, odds ratio [OR] 1.82, 95% CI 1.10-3.02). The difference was more profound for sustained response (60.5% vs 37.4%, OR 2.57, 95% CI 1.95-3.40). Network meta-analysis showed that dexamethasone plus recombinant human thrombopoietin ranked first for early response, followed by dexamethasone plus oseltamivir or tacrolimus. Rituximab plus prednisolone achieved highest sustained response, followed by dexamethasone plus all-trans retinoic acid or rituximab. Rituximab plus dexamethasone showed 15.3% of grade 3 or higher adverse events, followed by prednis(ol)one (4.8%) and all-trans retinoic acid plus dexamethasone (4.7%). INTERPRETATION Our findings suggested that compared with monotherapy dexamethasone or prednis(ol)one, the combined regimens had better early and sustained responses. rhTPO plus dexamethasone ranked top in early response, while rituximab plus corticosteroids obtained the best sustained response, but with more adverse events. Adding oseltamivir, all-trans retinoic acid or tacrolimus to dexamethasone reached equally encouraging sustained response, without compromising safety profile. Although this network meta-analysis compared all the therapeutic regimens up to date, more head-to-head RCTs with larger sample size are warranted to make direct comparison among these strategies. FUNDING National Natural Science Foundation of China, Major Research Plan of National Natural Science Foundation of China, Shandong Provincial Natural Science Foundation and Young Taishan Scholar Foundation of Shandong Province.
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Key Words
- AEs, adverse events
- ASH, American Society of Hematology
- All-trans retinoic acid
- Anti-D, Rho(D) immune globulin
- CI, confidence interval
- CrI, credible intervals
- DEX, dexamethasone
- Dexamethasone
- ITP, primary immune thrombocytopenia
- IVIg, intravenous immunoglobulin
- NMA, network meta-analysis
- Network meta-analysis
- OR, odds ratio
- OSE, oseltamivir
- Oseltamivir
- PRD, prednis(ol)one
- Prednis(ol)one
- Primary immune thrombocytopenia
- QoL, quality of life
- RA, all-trans retinoic acid
- RCTs, randomised controlled trials
- RTX, rituximab
- Randomized controlled trials
- Rituximab
- SUCRA, the surface under the cumulative ranking curve
- TAC, tacrolimus
- TPO-RAs, thrombopoietin receptor agonists
- Tacrolimus
- mPRD, methylprednisolone
- rhTPO
- rhTPO, recombinant human thrombopoietin
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Affiliation(s)
- Yun Wang
- Department of Hematology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Lei Sheng
- Department of General Surgery, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Fengjiao Han
- Department of Hematology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Qiuyu Guo
- Department of Hematology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Zihan Zhang
- Department of Hematology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Yu Hou
- Department of Hematology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Qi Feng
- Department of Hematology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Hai Zhou
- Department of Hematology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Xuebin Ji
- Department of Hematology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Jun Peng
- Department of Hematology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Jinan, China
- Advanced Medical Research Institute, Shandong University, Jinan, China
| | - Ming Hou
- Department of Hematology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Jinan, China
- Corresponding author. Department of Hematology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Wenhuaxi Road, Jinan, China.
| | - Miao Xu
- Department of Hematology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Jinan, China
- Corresponding author. Department of Hematology, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Wenhuaxi Road, Jinan, China.
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