Department of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Henan Engineering Research Center of Cancer Prevention and Control, Henan International Joint Laboratory of Cancer Prevention, Zhengzhou, China.
Beijing Ditan Hospital, Capital Medical University, Chaoyang, China.
Acta Haematol. 2023;146(3):173-184. doi: 10.1159/000528642. Epub 2022 Dec 26.
The aim of the study was to conduct a network meta-analysis to assess the efficacy and incidence of treatment-related adverse events (TRAEs) of eltrombopag, romiplostim, avatrombopag, recombinant human thrombopoietin (rhTPO), and hetrombopag for adult immune thrombocytopenia (ITP).
Randomized controlled trials (RCTs) of the five therapies from inception to June 1, 2022, were included. The efficacy outcome was the rate of platelet response, defined as the achievement of platelet counts above 50 × 109/L. Pairwise odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The surface under the cumulative ranking (SUCRA) was used to rank the included therapies for each outcome.
In total, 1,360 participants were analyzed in 14 eligible RCTs. All of the therapies showed a significantly better platelet response than the placebo, and avatrombopag (OR, 7.42; 95% CI: 1.74-31.69) and rhTPO (OR, 3.86; 95% CI: 1.62-9.18) were better than eltrombopag. Regarding TRAEs, no significant differences were found between patients receiving eltrombopag, romiplostim, and avatrombopag. Avatrombopag carried the highest platelet response rate with SUCRA value of 87.5, and carried the least TRAEs risk with SUCRA value of 37.0.
These findings indicated that avatrombopag appeared to be the optimal choice as the second-line therapy for adult ITP.
本研究旨在进行网状荟萃分析，以评估艾曲泊帕、罗米司亭、avatrombopag、重组人血小板生成素（rhTPO）和 hetrombopag 治疗成人免疫性血小板减少症（ITP）的疗效和治疗相关不良事件（TRAEs）的发生率。
纳入从研究开始至 2022 年 6 月 1 日的五种治疗方法的随机对照试验（RCT）。疗效结局为血小板反应率，定义为血小板计数达到 50×109/L 以上。计算了两两比值比（OR）和 95%置信区间（CI）。采用累积排序曲线下面积（SUCRA）对纳入的每种治疗方法进行排序。
共纳入 14 项合格 RCT 的 1360 名参与者。所有治疗方法的血小板反应均显著优于安慰剂，avatrombopag（OR，7.42；95%CI：1.74-31.69）和 rhTPO（OR，3.86；95%CI：1.62-9.18）优于艾曲泊帕。关于 TRAEs，接受艾曲泊帕、罗米司亭和 avatrombopag 的患者之间没有发现显著差异。avatrombopag 的血小板反应率最高，SUCRA 值为 87.5，TRAEs 风险最低，SUCRA 值为 37.0。
这些发现表明，avatrombopag 似乎是成人 ITP 二线治疗的最佳选择。
