Efficacy And Safety Of Eltrombopag In Treatment Of Immune Thrombocytopenia In Adults:A Meta-analysis

Objective:To systematically evaluate efficacy and safety of eltrombopag in treatment of adult immune thrombocytopenia(ITP).Methods:From the date of databases inception to October 30,2020,English databases,such as Pub Med,Embase,Cochrane library and others,as well as Chinese databases,such as Wanfang Date Knowledge Service Platform,Weipu Chinese Science and Technology Journal Database,China National Knowledge Infrastructure(CNKI)and Chinese Biomedical Literature Database(CBM)and others were searched to identify research literature of clinical researches of eltrombopag in treatment of ITP adult patients with study group receiving eltrombopag and control group receiving placebo in randomized controlled trials(RCT),and eltrombopag in treatment of ITP patients in single-arm clinical studies.Two researchers independently screened the literature according to the inclusion and exclusion criteria of the literatures set in this study,and evaluated the quality of the included literatures and extracted the materials.Efficacy and safety of eltrombopag in treatment of adult patients with ITP were Meta analyzed with Revman5.3.Main outcome evaluation indexes of effectiveness and safety of eltrombopag in treatment of adult patients with ITP include: effectiveness indicator(overall response rate and incidence rate of other ITP drugs reduction or discontinuation),safety indicators(incidence rate of overall adverse reactions,incidence rate of severe adverse reactions,and incidence rate of bleeding events).Results:Through literature screening,a total of 10 clinical researches met the inclusion criteria in this study,including 7 RCT and 3 single-arm clinical studies.A total of 872 adult patients with ITP were included.And 663 patients in study group and 209 patients in control group were included.Meta-analysis results of efficacy and safety of eltrombopag in treatment of adult ITP patients were as follows.Overall response rate of ITP adult patients in study group was higher than that of control group,and the difference was statistically significant(15.1% vs 65.1%,RR=4.18,95%CI:3.03～5.78,P<0.001).There were no statistically significant differences in incidence rate of overall adverse reactions(69.1% vs 67.4%)and severe adverse reactions(8.9% vs 8.8%)between study group and control group(RR=1.01,95%CI: 0.85～1.21,P=0.9;RR=0.93,95%CI: 0.56～1.55,P=0.79).Incidence rate of bleeding events in research group was lower than that of control group,and the difference was statistically significant(50.6% vs65.3%,RR=0.79,95%CI: 0.70～0.89,P < 0.01).Incidence rate of other ITP drugs reduction or discontinuation was 46%(95%CI: 41%～52%)during treatment of ITP adult patients with eltrombopag.Conclusion:Eltrombopag is effective in treatment of adult patients with ITP with higher safety and lower risk of bleeding.ITP adult patients who treated with eltrombopag may receive reduced does of other drugs to treat ITP.