Efficacy and safety of eltrombopag,avatrombopag and hetrombopag in patients with chronic immune thrombocytopenia:a systematic literature review and network analysis
WU Yi-hang
LU Yan-li
LUO Xian-dan
YANG Zhen-jiang
YAN Hui
HUANG Jin-yan
GUO Yan-xiang
YAN Xiao-ni
PANG Qiu-ling
ZHANG Hong-liang
Abstract：Objective:To systematically review the efficacy and safety of eltrombopag,avatrombopag and hetrombopag in the treatment of immune thrombocytopenia(ITP).Methods:The databases such as PubMed,Embase,Cochrane Library,Wanfang Database,CNKI,and CBM were searched,and the randomized controlled trials(RCT)related to the purpose of this study were collected from the database until October 1,2023.After two researchers independently screened the literature,extracted data,and evaluated the risk of bias in the included studies,a network Meta-analysis of the included literatures was performed using Revman 5.4 and R 4.3.2 software.Results:A total of nine RCT were included,including 1229 patients across three drugs.The results of mesh Meta-analysis showed that the overall platelet response rate of ITP patients treated with these medications was higher than that of placebo group,and the difference was statistically significant(P>0.05).The probability order was avatrombopag>hetrombopag>eltrombopag>placebo.The long-term platelet response rate of ITP treated with these medications was higher than that of placebo group,the difference was statistically significant(P>0.05),and the probability was avatrombopag>eltrombopag.In terms of the overall incidence of adverse events,the probability ranking from large to small incidence was avatrombopag>placebo>eltrombopag>hetrombopag.In terms of the incidence of serious adverse events,the probability ranking from large to small was avatrombopag>placebo>eltrombopag>hetrombopag.In terms of the incidence of all bleeding events,the probability ranking of the occurrence rate from large to small was placebo>eltrombopag>hetrombopag>avatrombopag.In terms of the incidence of clinically significant bleeding events,the probability ranking of the incidence from large to small was eltrombopag>placebo>avatrombopag>hetrombopag.There was no significant difference in the overall incidence of adverse events,the incidence of serious adverse events,the incidence of all bleeding events,and the incidence of clinically significant bleeding events among the four outcome indicators of eltrombopag,avatrombopag and hetrombopag compared with the placebo group(P>0.05).Conclusion:Eltrombopag,avatrombopag and hetrombopag are effective and safe in the treatment of ITP.Avatrombopag is the most effective option for the treatment of ITP,while hetrombopag is safest in the treatment of ITP.
Keywords：immune thrombocytopeniaeltrombopagavatrombopaghetrombopagsystematic review
Publication Date：2025-05-15
Online Publishing Date：2026-08-14(First online date of this platform, not the publication date of the document)
Pages：9( 1000-1008 )