Efficacy And Safety Of Thrombopoietin Receptor Agonists In Children With Chronic Immune Thrombocytopenic Purpura: Meta-Analysis

Background:Immune thrombocytopenic purpura(ITP)is an autoimmune disorder presenting with low platelet count<100×10~9/L.The condition affects both adults and children,less than 20%of pediatric cases may develop to chronic state.Thrombopoietin receptor agonists(TPO-RAs)are third line of therapy that includes Romiplostim and Eltrombopag which stimulates the production of normally functioning platelets.Aim:To synthesize evidence on the efficacy and safety of Romiplostim and Eltrombopag in children with chronic ITPMethods:Systematic literature search was conducted in the following database;PubMed,EMBASE and Cochrane Central Register of Controlled Trials(CENTRAL).Extracted records were screened for eligibility,and data was extracted and synthesized using review manager for windows.Review Manager 5.3 for Windows was used for analysis of data.Results:Five randomized controlled trials with total of 261 paediatric patients with age range from 1-17years were included in the final analysis.The outcome and safety analysis showed overall effect estimates favouring TPO-RA groups over placebo except in adverse events occurrence that showed no difference between TPO-RA(Romiplostim and Eltrombopag)over placebo groups;increased platelet count RR:4.31,95%CI[2.45--7.58];P<0.00001),incidence of bleeding events RR:0.62,95%CI:0.46–0.81,P=0.0007),number of cases needed rescue medications RR:0.48,95%CI:0.29–0.80,P=0.005)and adverse events(RR:1.04,95%CI:0.69–1.59,P=0.84)Conclusion:Both drugs are effective in treatment in chronic ITP in children.The efficacy and safety of Eltrombopag did not differ significantly from Romiplostim.