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Comparative efficacy of 19 drug therapies for patients with idiopathic thrombocytopenic purpura: a multiple-treatments network meta-analysis

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Abstract

Immune thrombocytopenia (ITP) is the most common clinical bleeding disorder with a high mortality rate and poor long-term survival quality in severe patients. There is controversy on how to choose the appropriate treatment. We systematically reviewed 19 randomized controlled trials (including 2615 participants) from January 1, 2015, to April 20, 2021. These investigations compared multiple drugs or their combinations in the therapeutic dose range for the treatment of ITP. The primary endpoint was based on the proportion of patients who responded to these therapies. The efficacy of eltrombopag plus rituximab, avatrombopag, dexamethasone plus anti-HP, and dexamethasone plus rhTPO was significantly higher than placebo (OR: 46.66, 29.44, 2.66, 1.86) or dexamethasone alone (OR: 46.22, 29.01, 2.22, 1.40). Placebo, oral immunosuppressants, and dexamethasone plus oseltamivir were less effective than the other ITP therapies tested. Eltrombopag plus rituximab may be the best choice when starting treatment for ITP.

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Data availability

All the data and materials were available if necessary.

Abbreviations

anti-HP:

Anti-helicobacter pylori

rhTPO:

Thrombopoietin

ITP:

Immune thrombocytopenia

HDD:

High-dose dexamethasone

MOOSE:

Meta-analysis of Observational Studies in Epidemiology

ORs:

Odds ratios

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Funding

This work was supported by the National Natural Science Foundation of China (81770193), Jiangsu Innovation Team (CXTDA2017014), and Social Development Project of Jiangsu Province (BE2017659). It was supported by the Department of Hematology and Oncology, The Children’s Hospital of Soochow University, Suzhou, China.

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  1. Department of Hematology and Oncology, The Children’s Hospital of Soochow University, No. 92, Zhongnan Street, Suzhou, China

    Huifeng Zhou, Junjie Fan, Jie He & Shaoyan Hu

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  1. Huifeng Zhou
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  2. Junjie Fan
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Contributions

Huifeng Zhou designed and performed research studies, analyzed the data, and wrote the manuscript. Junjie Fan and Jie He performed research studies and analyzed data. Shaoyan Hu contributed to the research design, data analysis, writing the manuscript, and supervision of the study.

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Correspondence to Shaoyan Hu.

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The study was approved by the Research Ethics Review Committee of Children’s Hospital of Soochow University and conducted following institutional guidelines and Helsinki’s Declaration. Informed consent was obtained from all patients before data collection.

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Huifeng Zhou, Junjie Fan, and Jie He are co-first authors.

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Zhou, H., Fan, J., He, J. et al. Comparative efficacy of 19 drug therapies for patients with idiopathic thrombocytopenic purpura: a multiple-treatments network meta-analysis. Ann Hematol 101, 953–961 (2022). https://doi.org/10.1007/s00277-022-04784-0

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