Effectiveness And Safety Of Rituximab Combined With Dexamethasone On The Treatment Of Primary Immune Thrombocytopenia:A Systematic Review

Objective:To conduct a Meta-analysis to evaluate the efficacy and safety of rituximab combined with dexamethasone on the treatment of primary immune thrombocytopenia (ITP)Methods:The Cochrane Library, PubMed, Embase, Medline, CBM Database, CNKI Database, WanFang Database and VIP Database were searched for the randomized controlled trials(RCTs) concerning the effectiveness and safety of rituximab combined with dexamethasone for ITP from the date of their establishment to April 2016.After filtrate the clinical research, we got complete response rate, total reaction rate, sustained response rate, recurrence rate, the levels of Treg cells, adverse events. Finally we used the meta-analysis of the data gathering from the studies by the software of RevMan 5.3.Results:A total of 11 studies involving 1070 patients were included in our Meta-analysis.533 receiving rituximab combined with dexamethasone in the trial group and 537 receiving dexamethasone. The Meta analysis results showed that the combination group, compared with the control group, was more effective in the complete response rate[RR=2.37,95%CI(1.74,3.23), P< 0.00001] and total reaction rate [RR=1.15,95%CI(1.04,1.28), P=0.009]after the treatment of 1 month, complete response rate[RR=6.63,95%CI(3.37,13.06), P <0.00001]and total effective rate[RR=2.64,95%CI(1.91,3.66),P< 0.00001] after the treatment of 3 months, sustained response rate [RR=2.83,95%CI (2.24,3.57), P<0.00001], recurrence rate[RR=0.46,95%CI (0.34,0.61), P< 0.00001];The levels of Treg cells were gradually increased in the combination group and significantly higher than those in the control group after the treatment of 14 days[MD=1.03,95%CI(0.85,1.20),P<0.00001] and28 days[MD=1.88, 95%CI (1.68,2.09), P<0.00001];The incidence of adverse reactions between the two group had significant difference[RR=1.39,95%CI (1.07,1.77),P=0.009], the combination group was higher than the control group.Conclusions:rituximab combined with dexamethasone therapy for primary immune thrombocytopenia is effective than dexamethasone. There is significant difference in complete response rate, total reaction rate, sustained response rate, recurrence rate, the levels of Treg cells, but the combination group had higher adverse events than the control group.