| Objective:This meta-analysis was conducted to determine the safety and efficacy of adding a thrombopoietin-receptor(THPO-R)agonist-Romiplostim and Eltrombopag to standard MDS treatment.Methods:Systematic electronic searched the records of Pub Med(2000 to February2017),EMBASE(2000 to February2017)and Cochrane Register of Controlled Trials(CENTRAL)(2000 to February2017),the conference proceedings of the American Journal of Hematology,the American Society of Clinical Oncology and the European Society of Hematology,as well as the bibliographies of relevant publications,with the randomized controlled trials comparing a THPO-R agonist to placebo to standard MDS treatment.Data collection and quality analysis were done.All the calculation and statistical tests were done withRev Man 5.3 and stata12.0 software.Relative risk is described by relative risk(RR)and 95% confidence interval(95%CI).I2 measures the share of heterogeneity in the effect size,if I2<50%,it means that there was no heterogeneity,a fixed effect model should be chosen in following analysis;other wise,when I2>50%,it means that there is heterogeneity,a random effects model should be chosen.The publication bias is evaluated by funnel plot,Begg’s and Egger’s test.Results:Eight RCTS were included for the systematic review and meta analysis and total 1003 patients met the inclusion criteria were included.The result of meta analysis showed the Platelet response rate in Thrombopoietin(THPO)-receptor agonists group was 38.8%which higher than in placebo group(11.0%);But the differences between the two groups have no statistical significance[RR=3.05,95%CI(0.78,11.92)P>0.05].The Platelet transfusion rate in Thrombopoietin(THPO)-receptor agonists group was 28.5% which less than in placebo group(32.4%)and differences between the two groups have statistical significance[RR=0.79,95%CI(0.65,0.97)P<0.05].The rate of bleeding event in Thrombopoietin(THPO)-receptor agonists group was 22.4% which less than in placebo group(32.0%);But the differences between the two groups have no statistical significance[RR=0.71,95%CI(0.43,1.17)P>0.05].The rate of serious bleeding event Thrombopoietin(THPO)-receptor agonists group was 5% which less than in placebo group(11.5%)and differences between the two groups have statistical significance[RR=0.45,95%CI(0.23,0.89)P<0.05].The CSTES rate of the two groups were similar[RR=0.84,95%CI(0.66,1.07)P>0.05]。The adverse event rate of the two groups were similar[RR=1.03,95%CI(0.98,1.08)P>0.05].The serious adverse event rate of the two groups were similar,too[RR=1.16,95%CI(0.81,1.65)P>0.05].The similar results occured in the rate of treatment-related adverse events [RR=1.17,95%CI(0.62,2.23)P>0.05].The result of meta analysis showed the rate of MDS develop into AML were similar(13.3%/12.0%)in the two groups[RR=1.24,95%CI(0.78,1.97)P>0.05].The similar results occurred in the rate of mortality(34.4%/34.7%)and RR=0.95,95%CI(0.79,1.13)P>0.05.Conclusion:Thrombopoietin(THPO)-receptor agonists Romiplostim and Eltrombopag are effective and safe on the aspect of treatment MDS.The Platelet transfusion rate and serious bleeding event was less than placebo.The rate of adverse event 、serious adverse event rate 、treatment-related adverse were similar in the two groups.The result of meta analysis showed the risk of AML progression with Thrombopoietin(THPO)-receptor agonists cannot be known with any great certainty from this study. |
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