Comparison of treatments for persistent/chronic immune thrombocytopenia: a systematic review and network meta-analysis

AbstractRecent studies have indicated that medical options without splenectomy, such as rituximab (RTX) or thrombopoietin receptor agonists (TPO-RAs), can be effective to treat persistent or chronic primary immune thrombocytopenia (ITP). However, it remains to be determined which of these strategies should be the first choice after the first-line treatment for newly diagnosed ITP. We performed a systematic review and network meta-analysis to establish a clinically meaningful hierarchy of the efficacy and safety of medical treatments for persistent or chronic ITP in adults. Randomized controlled trials (RCTs) evaluating medical treatments were included. Reviewers independently extracted data and assessed the risk of bias. The main outcome was the overall response (platelet≥ 50 × 109/L); incidence of bleeding episodes, necessity of rescue treatments, and therapy-related adverse events including thrombosis were the secondary endpoints. A total of 12 randomized controlled trials (N= 1306) were included in thi...