Recently, the Department of Hematology of Qilu Hospital of Shandong University published a paper in the prestigious international journal
eClinicalMedicine (CR Q1, IF= 17.033): Efficacy and safety of treatments in newly diagnosed adult primary immune thrombocytopenia: A systematic review and network meta-analysis. This paper analyzed and compared the efficacy and safety of all current treatments for newly diagnosed immune thrombocytopenia. Professor Xu Miao and Hou Ming of Qilu Hospital of Shandong University are co-corresponding authors of this article. Sheng Lei, attending physician of the Department of General Surgery of Qilu Hospital, and Wang Yun, graduate student of the Department of Hematology are co-first authors.
Primary immune thrombocytopenia is an acquired autoimmune disease characterized by thrombocytopenia, with a highly variable clinical presentation, ranging from asymptomatic thrombocytopenia to severe visceral bleeding and fatal intracranial hemorrhage, and often shows a chronic course of disease in adults. Studies have shown that the quality of life of ITP patients, especially chronic patients, is even lower than that of cancer patients, so it is significant for ITP patients to control the disease in the early stages of its development to achieve better remission and prevent progression to chronic ITP. The American Society of Hematology (ASH) recommends glucocorticoids for newly diagnosed ITP patients with an efficiency of up to 80%, but more than 50% of patients relapse during or after glucocorticoid tapering. In recent decades, based on the research on the pathogenesis of ITP, a variety of new drugs have been developed and drugs that have been currently applied to other diseases have been recombined and applied to the treatment of ITP. Unlike the traditional two-by-two comparison of meta-analysis, this study compared all treatment options simultaneously by direct and indirect comparisons, and ranked them according to effectiveness and safety, providing a basis for selecting the best treatment option for patients with newly diagnosed ITP.
The study strictly followed the PRISMA entry list and searched databases including PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases. After rigorous screening, 18 eligible articles (Figure 1) with a total of 11 treatment regimens were included in this study. The primary outcome are early remission and 6-month sustained remission, and the secondary outcome is grade ≥3 adverse events. The results showed that dexamethasone was slightly better than prednisone in terms of early remission (OR=1.71; 95% CI:0.67-4.34) (I2=80.0%,p=0.002) and sustained remission (OR=2.14; 95% CI:0.94-4.86) (I2=75.9%,p=0.001) (Figure 2). A higher proportion of early remission was achieved with the two-drug combination containing dexamethasone than with dexamethasone monotherapy (79.7% vs 68.7%, OR=1.82; 95% CI:1.10-3.02), and this difference was more pronounced for sustained remission (OR=2.57; 95% CI:1.95-3.40). The study performed meta-analysis in Bayesian framework using Markov Chain Monte Carlo approach and ranked various treatment options by using the surface under the cumulative ranking curve (SUCRA). The analysis showed that dexamethasone + recombinant human thrombopoietin (rhTPO) ranked first in terms of early remission (SUCRA=0.93) and rituximab + prednisone was at the top of the list in terms of sustained remission (SUCRA=0.85) (Figure 3). Adverse reactions of grade ≥3 occurred in 15.3% of patients treated with rituximab plus dexamethasone, a higher proportion than other treatment regimens. However, almost all adverse events were manageable, and treatment-related deaths were rare. In addition, sensitivity analysis was performed in this study to test the stability of the findings.
Figure 1 Retrieval strategy
Figure 2 Paired comparison of early remission and sustained remission
Figure 3 Summary comparison of early remission and sustained remission
Prof. Hou Ming and Prof. Xu Miao's team has been working on the basic and clinical research of ITP for a long time, and has published a series of important research results in
Blood, American journal of Hematology, Lancet Hematology and other journals in recent years. The research has been supported by the National Natural Science Foundation of China, the National Natural Major Research Program Integration Program, the Natural Science Foundation of Shandong Province, and the Taishan Scholar Young Experts Program, etc.
Link：
https://doi.org/10.1016/j.eclinm.2022.101777
