OBJECTIVE To systematically evaluate the efficacy and safety of corticosteroids combined with thrombopoietin receptor agonist(TPO-RA) in treating adult primary immune thrombocytopenia(ITP).
METHODS Literatures were retrieved from CNKI, VIP, Wanfang, CBM, PubMed, EMbase, and the Cochrane Library database, with the retrieval time limit from the establishment of each database to December 23, 2024. Randomized controlled trials(RCTs) regarding the treatment of adult primary ITP with corticosteroids combined with TPO-RAs were collected. After literature screening, data extraction and quality evaluation of the included studies, meta-analysis was performed using RevMan 5.4 and StataNow 18 MP software.
RESULTS Nine RCTs involving a total of 567 patients were included. Meta-analysis showed that compared with corticosteroid or TPO-RA monotherapy, corticosteroid combined with TPO-RA had significantly higher overall clinical efficacyRR=1.30, 95%CI(1.20, 1.41), P<0.00001 and enhanced effect of elevating platelet levelsRR=1.59, 95%CI(1.32, 1.92), P<0.00001; the incidence of adverse events was not statistically significant when comparing the 2 groupsRR=0.73, 95%CI(0.48, 1.13), P=0.16.
CONCLUSION Versus treatment with corticosteroids alone, or TPO-RA, corticosteroids in combination with TPO-RA may improve the efficiency of treating adult primary ITP and increase platelet levels more effectively, with no elevated risk of adverse effects.
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