Li Ting, Liu Qinqin, Pu Ting, Liu Jing, Zhang Aijun
Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China.
Department of Biostatistics, School of Public Health, Cheeloo College of Medicin, Shandong University, Jinan, China.
Expert Opin Pharmacother. 2023 Apr;24(6):763-774. doi: 10.1080/14656566.2023.2198089. Epub 2023 Apr 6.
In this paper, we systematically review the efficacy and safety of thrombopoietin receptor agonists (TPORAs) for treatment of persistent and chronic immune thrombocytopenia (ITP) in children and adults.
We searched PubMed, MEDLINE, ScienceDirect, Scopus, EMbase and the Cochrane Library to collect randomized controlled trials (RCTs) of TPO-RAs which including avatrombopag hetrombopag eltrombopag and romiplostim treated persistent and chronic ITP from their earliest records to February 2022.
We included 15 RCTs with a total of 1563 patients. There were ten trials of adults and five trials of children. The results of meta-analysis showed that in adult patients, patients treated with TPO-RAs had longer duration of platelet response, higher platelet response rate, lower use of rescue therapy, and lower incidence of bleeding events, and similar incidence of adverse events compared with placebo. Except for the incidence of any bleeding, the results in children were consistent with those in adults. The network meta-analysis of data on overall platelet response rates in adults showed that avatrombopag was more effective than eltrombopag and hetrombopag.
TPO-RAs has better efficacy and higher safety in the treatment of ITP. And the overall response rate of avatrombopag in adults was higher than that in eltrombopag and hetrombopag.
在本文中，我们系统回顾了血小板生成素受体激动剂（TPORAs）治疗儿童和成人持续性及慢性免疫性血小板减少症（ITP）的疗效和安全性。
我们检索了PubMed、MEDLINE、ScienceDirect、Scopus、EMbase和Cochrane图书馆，以收集从最早记录至2022年2月的血小板生成素受体激动剂（TPO-RAs）的随机对照试验（RCTs），这些试验包括阿伐曲泊帕、海曲泊帕、艾曲泊帕和罗米司亭治疗持续性及慢性ITP。
我们纳入了15项RCTs，共1563例患者。其中成人试验10项，儿童试验5项。荟萃分析结果显示，在成年患者中，与安慰剂相比，接受TPO-RAs治疗的患者血小板反应持续时间更长、血小板反应率更高、挽救治疗使用率更低、出血事件发生率更低，不良事件发生率相似。除任何出血发生率外，儿童的结果与成人一致。对成人总体血小板反应率数据的网状荟萃分析表明，阿伐曲泊帕比艾曲泊帕和海曲泊帕更有效。
TPO-RAs治疗ITP具有更好的疗效和更高的安全性。且阿伐曲泊帕在成人中的总体反应率高于艾曲泊帕和海曲泊帕。
