| BackgroundPrimary immune thrombocytopenia(ITP)is a common acquired autoimmune disease with obvious bleeding tendency and characterized by simple thrombocytopenia in peripheral blood,which can occur in different ages.Most of its adult patients usually develop chronic ITP.The pathogenesis of this disease is complex.At present,the research on its pathogenesis mainly focuses on two aspects:the increase of platelet destruction and the decrease of platelet production.The course of ITP is usually prolonged and easy to recur,and there is the possibility of fatal bleeding events.Glucocorticoid and intravenous injection of large dose of gamma globulin are the first-line treatment drugs for the disease,mainly through reducing the production of autoantibodies,neutralizing complement,regulating cytokines and other functions to reduce the platelet destruction,so as to achieve the purpose of treatment.However,clinical data show that only about 80%of patients respond to the first-line treatment,and some patients will relapse or have drug dependence,and even some patients suffer from the side effects of the drug.Eltrombopag,as a oral thrombopoietin receptor agonist(TRA),can simulate the role of endogenous thrombopoietin,bind to the surface related receptor(c-MPL)of megakaryocytes,activate the downstream pathways to promote platelet production.In recent years,a large number of clinical studies have confirmed that eltrombopag has obvious advantages in the treatment of ITP.Domestic experts of primary immune thrombocytopenia have also agreed that it should be included in the second-line treatment of ITP.ObjectiveThis study aims at evaluating the treatment effect and the tolerance of eltrombopag in the adult persistent or chronic primary immune thrombocytopenia.MethodsComprehensively search the six major domestic and foreign mainstream medical databases(web of science,PubMed,EMBASE,the Cochrane Library,CNKI and Wanfang Data knowledge service platform),collect the domestic and foreign researchers published literature on eltrombopag treatment ITP,and set time to start from the establishment of the database to February 2020.Two researchers used the online data set to independently select literature in strict accordance with the inclusion and exclusion criteria,and extracted data from the selected literature.After sorting out,we use the Revman 5.3 software provided by Cochrane Collaboration Network to evaluate the quality,heterogeneity test and data statistical analysis of all the included literature In order to evaluate the efficacy and safety of eltrombopag in the treatment of adult persistent or chronic ITP,we systematically analyzed the treatment efficiency,the incidence of bleeding events,the incidence of thrombosis events,the incidence of adverse events and the rescue therapy.ResultA total of 606 subjects were included in this research,418 of them in the experimental group and 188 in the control group.Here are the mainly results of this meta-analysis:①The total and 2-week effective rate of eltrombopag in the treatment of adult persistent or chronic ITP were higher than those of placebo group,the relative risk was[RR=4.91,95%CI(3.27,7.38),P<0.00001]and[RR=7.04,95%CI(3.64,13.61),P<0.00001],respectively.The difference was statistically significant.②During the treatment,the incidence of bleeding events was lower in eltrombopag group than in placebo group,and the relative risk was[RR=0.82,95%CI(0.73,0.92),P<0.01].③We had not found significant statistical difference in the incidence of thrombotic events or adverse events between two groups.The relative risks were[RR=2.14,95%CI(0.37,12.45),P=0.40]and[RR=1.05,95%CI(0.84,1.32),P=0.68],respectively.④In terms of rescue therapy,compared with placebo group,eltrombopag group showed significant advantages,with a relative risk of[RR=0.37,95%CI(0.25,0.54),P<0.00001].ConclusionEltrombopag has a good effect in the treatment of adult persistent or chronic ITP,and it has a rapid onset,good safety and tolerance.It can be a new choice for clinical treatment of persistent or chronic ITP. |
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