Efficacy Of Eltrombopag And Romiplostim In The Treatment Of Chronic ITP In Children:A Meta Analysis

Objective: Primary immune thrombocytopenia is an acquired autoimmune disease.There are two main pathogenesis.One is that immune factors lead to excessive platelet destruction,another is that megakaryocyte maturation disorder leads to insufficient platelet production.Most children's ITP is self-limited.20-30% of patients develop into chronic or refractory ITP.The first-line drugs of treatment ITP has a better effect on most patients,but it has a poor effect on a few patients with ITP.Thrombopoietin-receptor agonists(eltrombopag and romiplostim)have become new choices in recent years.Therefore,this article aims to evaluate the efficacy and safety of eltrombopag and romiplostim in the treatment of immune thrombocytopenia(ITP)in children.Methods: Literatures published by scholars at home and abroad on the treatment of chronic ITP from February 1,2019 were searched comprehensively.Several major medical databases,including Wangfang Data Knowledge Service Platform,VIP,CNKI,were searched.China Dissertation Database,Web of Science,PubMed,EMbase,The Cochrane Library.Two researchers independently screened and summarized their opinions according to inclusion and exclusion criteria,extracted data from the final articles and evaluated the quality of the included documents.Revman 5.3 software was used for statistical analysis of the data.The main observational indicators included treatment efficiency,adverse reactions and incidence of serious adverse reactions,incidence of bleeding events and remedial treatment.Examples and so on.To systematically evaluate the efficacy and safety of eltrombopag and romiplostim in the treatment of chronic ITP.Results: A total of 5 literatures were retrieved to meet the inclusion criteria.Meta-analysis showed that the efficacy of eltrombopag and romiplostim in the treatment of chronic ITP was better than that of placebo group.The difference was statistically significant.The relative risk was [RR = 2.64,95% CI(1.58,4.44),P < 0.01] and RR= 5.05,[95% CI(2.21,11.53),P < 0.01].eltrombopag and romiplostim were tested by Chi-square test = 4.69 P < 0.05.The difference was statistically significant.Romiplostim efficacy was better than Eltrombopag in the treatment of ITP.There was no significant difference in the incidence of adverse reactions and serious adverse reactions between the Eltrombopag,Romiplostim and placebo groups,and the relative risk was [RR=0.97,95%CI(0.72,1.29),P>0.05]?[RR=1.12,95%CI(0.16,7.80),P>0.05] and [RR=0.95,95%CI(0.69,1.31),P > 0.05] ?[RR=1.65,95%CI(0.53,5.31),P > 0.05].There was no significant difference in the incidence of bleeding events between placebo group and placebo group.The relative risk was [RR = 1.0,95% CI(0.82,1.21),P > 0.05] and [RR = 1.27,95% CI(0.92,1.75),P > 0.05].There was no significant difference in the rescue treatment between eltrombopag,romiplostim and placebo group,and the relative risk was [RR = 0.46,95% CI(0.16,1.34),P > 0.05] and[RR = 0.58,95% CI(0.29,1.17).P > 0.05].Conclusions: Comparedwith the control group,eltrombopag and romiplostim are more effective in the treatment of chronic ITP,and romiplostim is more effective in the treatment of chronic ITP than eltrombopag.For the incidence of adverse reactions,There was no significant difference between romiplostim and eltrombopag as compared with the control group,and eltrombopag and romiplostim have good tolerance and mild adverse reactions in the treatment process.Both of them are effective and safe,and can become a new choice for the clinical treatment of chronic ITP in children.