Efficacy and safety of treatments in newly diagnosed adult primary immune thrombocytopenia: A systematic review and network meta-analysis.
Efficacy and safety of treatments in newly diagnosed adult primary immune thrombocytopenia: A systematic review and network meta-analysis.
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新诊断成人原发性免疫性血小板减少症治疗的有效性和安全性：系统评价和网络荟萃分析。
DOI：
10.1016/j.eclinm.2022.101777
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发表时间：
2023-02
影响因子：
15.1
通讯作者：
Xu, Miao
中科院分区：
文献类型：
--
作者：
Wang, Yun;Sheng, Lei;Han, Fengjiao;Guo, Qiuyu;Zhang, Zihan;Hou, Yu;Feng, Qi;Zhou, Hai;Ji, Xuebin;Peng, Jun;Hou, Ming;Xu, Miao
关键词：
免疫性血小板减少症是一种以血小板计数减少为特征的自身免疫性疾病。近年来，人们在随机对照试验（RCTs）中研究了新的治疗方案。我们的目的是比较不同治疗方法对新诊断的成人原发性免疫性血小板减少症的疗效和安全性。我们对涉及新诊断原发性免疫性血小板减少症治疗的随机对照试验进行了系统回顾和网络荟萃分析。PubMed、Embase、Cochrane Central Register of Controlled Trials和ClinicalTrials.gov数据库被检索到2022年4月31日。主要结局为6个月持续缓解和早期缓解。次要结局是3级或更高的不良事件。本研究已在PROSPERO注册（CRD42022296179）。本研究共纳入18项随机对照试验（n = 1944）。成对荟萃分析显示，在含地塞米松双药组中获得早期缓解的患者比例高于地塞米松组（79.7% vs 68.7%，优势比[OR] 1.82, 95% CI 1.10-3.02）。在持续反应方面差异更大（60.5% vs 37.4%, OR 2.57, 95% CI 1.95-3.40）。网络荟萃分析显示，地塞米松联合重组人血小板生成素在早期反应中排名第一，其次是地塞米松联合奥司他韦或他克莫司。利妥昔单抗联合强的松龙获得最高的持续疗效，其次是地塞米松联合全反式维甲酸或利妥昔单抗。利妥昔单抗联合地塞米松的3级及以上不良事件发生率为15.3%，其次是普雷尼（ol） 1（4.8%）和全反式维甲酸联合地塞米松（4.7%）。我们的研究结果表明，与单药地塞米松或泼尼松（ol）相比，联合治疗方案具有更好的早期和持续反应。rhTPO联合地塞米松的早期反应最好，而利妥昔单抗联合糖皮质激素的持续反应最好，但不良事件较多。在地塞米松中加入奥司他韦、全反式维甲酸或他克莫司同样令人鼓舞的持续反应，且不影响安全性。尽管该网络荟萃分析比较了最新的所有治疗方案，但需要更多样本量更大的正面随机对照试验来对这些策略进行直接比较。，重大研究计划，和青年。
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. 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). 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%). 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. , Major Research Plan of , and Young .
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影响因子：
16.6
作者：
Li J;van der Wal DE;Zhu G;Xu M;Yougbare I;Ma L;Vadasz B;Carrim N;Grozovsky R;Ruan M;Zhu L;Zeng Q;Tao L;Zhai ZM;Peng J;Hou M;Leytin V;Freedman J;Hoffmeister KM;Ni H
通讯作者：
Ni H
影响因子：
5.7
作者：
Cuker, Adam;Prak, Eline T. Luning;Cines, Douglas B.
通讯作者：
Cines, Douglas B.
DOI：
10.3760/cma.j.issn.0253-2727.2013.10.012
发表时间：
2013-10-01
影响因子：
--
作者：
Gu, Shi-yang;Zhuang, Jing-li;Wei, Zheng
通讯作者：
Wei, Zheng
影响因子：
7.5
作者：
Dai, Lan;Zhang, Ri;Ruan, Chang-geng
通讯作者：
Ruan, Chang-geng
影响因子：
2.8
作者：
Bussel, James;Cooper, Nichola;Newland, Adrian
通讯作者：
Newland, Adrian