Safety and Efficacy of Eltrombopag and Romiplostim in Myelodysplastic Syndromes: A Systematic Review and Meta-Analysis
Background and AimMany studies indicated that eltrombopag and romiplostim could improve hematopoietic function in patients with myelodysplastic syndromes (MDS), but their toxicity and efficacy were not known. This meta-analysis aimed to investigate the safety and efficacy of eltrombopag and romiplos...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-11-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2020.582686/full |
| _version_ | 1818648784249290752 |
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| author | Fanqiao Meng Xiuqiong Chen Shunjie Yu Xiaotong Ren Zhaoyun Liu Rong Fu Lijuan Li |
| author_facet | Fanqiao Meng Xiuqiong Chen Shunjie Yu Xiaotong Ren Zhaoyun Liu Rong Fu Lijuan Li |
| author_sort | Fanqiao Meng |
| collection | DOAJ |
| description | Background and AimMany studies indicated that eltrombopag and romiplostim could improve hematopoietic function in patients with myelodysplastic syndromes (MDS), but their toxicity and efficacy were not known. This meta-analysis aimed to investigate the safety and efficacy of eltrombopag and romiplostim in MDS.MethodsA full-scale search strategy was used to search relevant published studies in PubMed, Embase, Web of Science, ClinicalTrials.gov and the Cochrane Library until January 2020 using a random-effects model and the pooled risk ratio (RR) with 95% confidence interval as the effect indicator. Statistical analyses were performed using RevMan 5.3.ResultsThis meta-analysis included eight studies comprising 1047 patients. A lower RR of overall response rate (ORR) (RR: 0.65; 95% CI, 0.47–0.9) and grade ≥3 bleeding events (RR: 0.36; 95% CI, 0.36–0.92) were observed after romiplostim and eltrombopag treatment compared with placebo. The pooled RR for the ORR and grade ≥3 bleeding events were 0.58 (95% CI: 0.41–0.83, P = 0.003) and 0.6 (95% CI: 0.37–0.96, P = 0.03) in eltrombopag, respectively. A lower ORR in intermediate- or high-risk MDS (RR: 0.63; 95% CI: 0.45–0.88, P = 0.006) was observed. No difference in mortality, serious adverse events, platelet transfusion, hematologic improvement, and AML transformation was observed.ConclusionsThrombopoietin receptor agonists (TPO-RAs) romiplostim and eltrombopag were effective in reducing bleeding events, especially grade ≥3 bleeding events. However, it might reduce the ORR of MDS, especially in eltrombopag treatment group or high-risk MDS group. Due to the limited treatment of MDS and the poor response to the drug, this may be a selection method for MDS combined with fatal bleeding, although further research is needed to confirm the effectiveness of this approach. |
| first_indexed | 2024-12-17T01:23:56Z |
| format | Article |
| id | doaj.art-3e47324590af4c2ca4b651b3d2e19d16 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-17T01:23:56Z |
| publishDate | 2020-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-3e47324590af4c2ca4b651b3d2e19d162022-12-21T22:08:44ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2020-11-011010.3389/fonc.2020.582686582686Safety and Efficacy of Eltrombopag and Romiplostim in Myelodysplastic Syndromes: A Systematic Review and Meta-AnalysisFanqiao Meng0Xiuqiong Chen1Shunjie Yu2Xiaotong Ren3Zhaoyun Liu4Rong Fu5Lijuan Li6Hematology Department of Tianjin, Medical University General Hospital, Tianjin, ChinaCancer Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, ChinaHematology Department of Tianjin, Medical University General Hospital, Tianjin, ChinaHematology Department of Tianjin, Medical University General Hospital, Tianjin, ChinaHematology Department of Tianjin, Medical University General Hospital, Tianjin, ChinaHematology Department of Tianjin, Medical University General Hospital, Tianjin, ChinaHematology Department of Tianjin, Medical University General Hospital, Tianjin, ChinaBackground and AimMany studies indicated that eltrombopag and romiplostim could improve hematopoietic function in patients with myelodysplastic syndromes (MDS), but their toxicity and efficacy were not known. This meta-analysis aimed to investigate the safety and efficacy of eltrombopag and romiplostim in MDS.MethodsA full-scale search strategy was used to search relevant published studies in PubMed, Embase, Web of Science, ClinicalTrials.gov and the Cochrane Library until January 2020 using a random-effects model and the pooled risk ratio (RR) with 95% confidence interval as the effect indicator. Statistical analyses were performed using RevMan 5.3.ResultsThis meta-analysis included eight studies comprising 1047 patients. A lower RR of overall response rate (ORR) (RR: 0.65; 95% CI, 0.47–0.9) and grade ≥3 bleeding events (RR: 0.36; 95% CI, 0.36–0.92) were observed after romiplostim and eltrombopag treatment compared with placebo. The pooled RR for the ORR and grade ≥3 bleeding events were 0.58 (95% CI: 0.41–0.83, P = 0.003) and 0.6 (95% CI: 0.37–0.96, P = 0.03) in eltrombopag, respectively. A lower ORR in intermediate- or high-risk MDS (RR: 0.63; 95% CI: 0.45–0.88, P = 0.006) was observed. No difference in mortality, serious adverse events, platelet transfusion, hematologic improvement, and AML transformation was observed.ConclusionsThrombopoietin receptor agonists (TPO-RAs) romiplostim and eltrombopag were effective in reducing bleeding events, especially grade ≥3 bleeding events. However, it might reduce the ORR of MDS, especially in eltrombopag treatment group or high-risk MDS group. Due to the limited treatment of MDS and the poor response to the drug, this may be a selection method for MDS combined with fatal bleeding, although further research is needed to confirm the effectiveness of this approach.https://www.frontiersin.org/articles/10.3389/fonc.2020.582686/fulleltrombopagmeta-analysismyelodysplastic syndromesromiplostimthrombocytopenia |
| spellingShingle | Fanqiao Meng Xiuqiong Chen Shunjie Yu Xiaotong Ren Zhaoyun Liu Rong Fu Lijuan Li Safety and Efficacy of Eltrombopag and Romiplostim in Myelodysplastic Syndromes: A Systematic Review and Meta-Analysis Frontiers in Oncology eltrombopag meta-analysis myelodysplastic syndromes romiplostim thrombocytopenia |
| title | Safety and Efficacy of Eltrombopag and Romiplostim in Myelodysplastic Syndromes: A Systematic Review and Meta-Analysis |
| title_full | Safety and Efficacy of Eltrombopag and Romiplostim in Myelodysplastic Syndromes: A Systematic Review and Meta-Analysis |
| title_fullStr | Safety and Efficacy of Eltrombopag and Romiplostim in Myelodysplastic Syndromes: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Safety and Efficacy of Eltrombopag and Romiplostim in Myelodysplastic Syndromes: A Systematic Review and Meta-Analysis |
| title_short | Safety and Efficacy of Eltrombopag and Romiplostim in Myelodysplastic Syndromes: A Systematic Review and Meta-Analysis |
| title_sort | safety and efficacy of eltrombopag and romiplostim in myelodysplastic syndromes a systematic review and meta analysis |
| topic | eltrombopag meta-analysis myelodysplastic syndromes romiplostim thrombocytopenia |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2020.582686/full |
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