PMID- 30661482
OWN - NLM
STAT- MEDLINE
DCOM- 20190228
LR  - 20211204
IS  - 1607-8454 (Electronic)
IS  - 1024-5332 (Linking)
VI  - 24
IP  - 1
DP  - 2019 Dec
TI  - Therapeutic options for adult patients with previously treated immune 
      thrombocytopenia - a systematic review and network meta-analysis.
PG  - 290-299
LID - 10.1080/16078454.2019.1568659 [doi]
AB  - OBJECTIVES: The great majority of adult patients with immune thrombocytopenia 
      (ITP) who fail to respond to first-line medication or who relapse following 
      response require additional treatment. Although broad guidelines currently exist 
      for second-line and subsequent therapies, none to date have been prescriptive. 
      The purpose of this systematic review and network meta-analysis was to establish 
      a clinically relevant ranking of the efficacy and safety of medications for 
      adults (>/=18 years old) with previously treated ITP. METHODS: Relevant 
      publications from Medline, Embase, and the Cochrane database were searched from 
      their inceptions through July 31, 2018. The primary outcome was the overall 
      response (OR, defined as a platelet count >/=50 x 10(9)/L at the end of treatment 
      without rescue therapy), while the secondary endpoints included early response 
      (ER; i.e. a platelet count >/=50 x 10(9)/L at week 2 after initiation of treatment) 
      and therapy-related severe adverse events (AEs). RESULTS: Thirteen randomized 
      controlled trials (1,202 patients) were included in this study. According to 
      pooled results, romiplostim appears to be the most suitable treatment in terms of 
      OR, followed by avatrombopag, eltrombopag, fostamatinib, and rituximab. 
      Avatrombopag produced more satisfactory outcomes than romiplostim, eltrombopag, 
      and rituximab in terms of ER; severe AEs profiles were similar across all 
      treatment arms. CONCLUSION: Romiplostim appears to be the best option for 
      patients who fail to respond to prior treatment or relapse thereafter, while 
      avatrombopag and eltrombopag are reasonable alternatives. Rituximab monotherapy 
      is not recommended, as it produces the lowest OR and ER rates.
FAU - Yang, Ran
AU  - Yang R
AUID- ORCID: 0000-0002-1097-3573
AD  - a Department of Hematology , Affiliated Hospital of Nanjing University of Chinese 
      Medicine , Nanjing , People's Republic of China.
FAU - Lin, Lin
AU  - Lin L
AD  - a Department of Hematology , Affiliated Hospital of Nanjing University of Chinese 
      Medicine , Nanjing , People's Republic of China.
FAU - Yao, Hao
AU  - Yao H
AD  - a Department of Hematology , Affiliated Hospital of Nanjing University of Chinese 
      Medicine , Nanjing , People's Republic of China.
FAU - Ji, Ou
AU  - Ji O
AD  - a Department of Hematology , Affiliated Hospital of Nanjing University of Chinese 
      Medicine , Nanjing , People's Republic of China.
FAU - Shen, Qun
AU  - Shen Q
AD  - a Department of Hematology , Affiliated Hospital of Nanjing University of Chinese 
      Medicine , Nanjing , People's Republic of China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
PL  - England
TA  - Hematology
JT  - Hematology (Amsterdam, Netherlands)
JID - 9708388
RN  - 0 (Aminopyridines)
RN  - 0 (Benzoates)
RN  - 0 (Hydrazines)
RN  - 0 (Morpholines)
RN  - 0 (Oxazines)
RN  - 0 (Pyrazoles)
RN  - 0 (Pyridines)
RN  - 0 (Pyrimidines)
RN  - 0 (Receptors, Fc)
RN  - 0 (Recombinant Fusion Proteins)
RN  - 0 (Thiazoles)
RN  - 0 (Thiophenes)
RN  - 3H8GSZ4SQL (avatrombopag)
RN  - 4F4X42SYQ6 (Rituximab)
RN  - 9014-42-0 (Thrombopoietin)
RN  - GN5XU2DXKV (romiplostim)
RN  - S56D65XJ9G (eltrombopag)
RN  - SQ8A3S5101 (fostamatinib)
SB  - IM
MH  - Adult
MH  - Aminopyridines
MH  - Benzoates/*therapeutic use
MH  - Humans
MH  - Hydrazines/*therapeutic use
MH  - Morpholines
MH  - Oxazines/*therapeutic use
MH  - Purpura, Thrombocytopenic, Idiopathic/*drug therapy/immunology/pathology
MH  - Pyrazoles/*therapeutic use
MH  - Pyridines/*therapeutic use
MH  - Pyrimidines
MH  - Randomized Controlled Trials as Topic
MH  - Receptors, Fc/*therapeutic use
MH  - Recombinant Fusion Proteins/*therapeutic use
MH  - Rituximab/*therapeutic use
MH  - Thiazoles/*therapeutic use
MH  - Thiophenes/*therapeutic use
MH  - Thrombopoietin/*therapeutic use
OTO - NOTNLM
OT  - Immune thrombocytopenia
OT  - early response
OT  - meta-analysis
OT  - overall response
OT  - previously treated
OT  - second-line therapy
OT  - systematic review
OT  - therapeutic options
EDAT- 2019/01/22 06:00
MHDA- 2019/03/01 06:00
CRDT- 2019/01/22 06:00
PHST- 2019/01/22 06:00 [entrez]
PHST- 2019/01/22 06:00 [pubmed]
PHST- 2019/03/01 06:00 [medline]
AID - 10.1080/16078454.2019.1568659 [doi]
PST - ppublish
SO  - Hematology. 2019 Dec;24(1):290-299. doi: 10.1080/16078454.2019.1568659.