Evidence-Based Evaluation of the Use of Avatrombopag in Patients with Primary Immune Thrombocytopenia
OBJECTIVE Evaluate the evidence of avatrombopag in the treatment of primary immune thrombocy-topenia to provide evidence-based basis for the off-label drug use of avatrombopag.METHODS Systematic re-views/Meta-analyses of avatrombopag on primary immune thrombocytopenia were searched using the following data-base:PubMed,Embase,Cochrane Library,CNKI,VIP and Wanfang database,The A Measurement Tool to Assess Sys-tematic Reviews 2(AMSTAR 2)scale was used to evaluate the methodological quality of the included studies.And foreign drug instruction website and Micromedex evidence-based database were also searched and data were extrac-ted.RESULTS A total of five Meta-analyses,the FDA and EMA package insert,data from Micromedex,four 4 ex-pert consensuses were included.Compared with placebo,avatrombopag statistically significant improvements in plate-let response,early platelet responses,durable platelet response,reduction in use of concomitant ITP medica-tion.Avatrombopag is preferred over eltrombopag,romiplostim,hetrombopag,rituximab alone or in combination with recombinant human thrombopoietin(rhTPO)for platelet response.Early platelet response is also superior to ritux-imab.And the incidence of bleeding events in avatrombopag was significantly lower than that of placebo,eltrombopag and romiplostim.In terms of safety,there was no significant difference in the incidence of adverse events between avatrombopag and placebo,eltrombopag and romiplostim.Avatrombopag produced more satisfactory outcomes than placebo,eltrombopag,and romiplostim in terms of incidence of bleeding episodes.Severe AEs profiles were similar across all 5 arms.One study was of low quality and five were of very-low quality in methodological quali-ty.CONCLUSION Avatrombopag was effective in the treatment of Immune thrombocytopenia,Chronic;with insuf-ficient response to previous treatment.The evidence-based basis of avatrombopag is insufficient and low-quality.More high-quality researches are still needed for further investigation.
万方数据
维普
