Efficacy and Safety of Low-dose Cyclosporine Combined with Levamisole in the Treatment of Non-severe Aplastic Anemia: A Meta-analysis

OBJECTIVE To systematically evaluate the efficacy and safety of low-dose cyclosporine combined with levamisole in the treatment of non-severe aplastic anemia(NSAA). METHODS The Cochrane Library, EMbase, PubMed, CBM, CNKI, VIP and Wanfang database were searched from inception to July 2019 to collect randomized controlled trials of low-dose cyclosporine combined with levamisole in the treatment of NSAA. Two reviewers independently screened studies, extracted date, and evaluated risk of bias of included studies. Meta-analysis was performed using RevMan 5.3 software. RESULTS Twelve literatures with a total of 1 071 patients were involved in this research. Meta-analysis showed that the total effective rate of low-dose cyclosporine combined with levamisole and standard dose cyclosporine in the treatment of NSAA was not statistically significant differentOR=1.23, 95% CI(0.82, 1.86), P=0.31. However, there was statistically significance difference in the incidence of adverse reactions between the two therapeutic regimentsOR=0.10, 95% CI(0.07, 0.16), P<0.000 01. And in terms of hematological indicators, the changes of hemoglobinMD=1.83，95% CI(-1.55, 5.20), P=0.29, neutrophilsMD=-0.03, 95% CI(-0.19, 0.13), P=0.69 and reticulocytesMD=-1.24, 95% CI(-3.54, 1.05), P=0.29 in the two groups were not statistically significant different, but there was statistically significant difference in the change of platelet between the two therapeutic regiments MD=18.23, 95% CI (14.54, 21.92), P<0.000 01. CONCLUSION The total effective rate of low dose cyclosporine combined with levamisole is comparable to standard dose cyclosporine in the treatment of NSAA. But the adverse reactions is lower and the platelet levels is higher in low dose cyclosporine combined with levamisole. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.