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. 2021 May 25:8:656792.
doi: 10.3389/fmed.2021.656792. eCollection 2021.

The Efficacy of High-Dose Dexamethasone vs. Other Treatments for Newly Diagnosed Immune Thrombocytopenia: A Meta-Analysis

Qirong Xiao  1   2 , Bicun Lin  1   2 , Hanyu Wang  1 , Weiwu Zhan  1   2 , Ping Chen  1   2
Affiliations

The Efficacy of High-Dose Dexamethasone vs. Other Treatments for Newly Diagnosed Immune Thrombocytopenia: A Meta-Analysis

Qirong Xiao et al. Front Med (Lausanne). .

Abstract

Objective: To compare the therapeutic efficacies of high dose dexamethasone, prednisone and rituximab in combination with dexamethasone for newly diagnosed ITP (Immune Thrombocytopenia, ITP) patients. Methods and results: Relevant publications for this study were obtained by searching PubMed, Embase, Cochrane, and CNKI (National Knowledge Infrastructure, CNKI) databases following the PRISMA guidelines. A total of, 15 publications were retrieved that contained sufficient data from 1,362 patients for high quality analysis of this study endpoints. Data analysis was carried out using Stata 11.0 software. The primary outcomes were OR (Overall Response, OR) at 1 month after intervention and SR at 6 and 12 months. The secondary outcomes were AEs and relapse. There were no differences in the OR, while the SR was higher at 6 months (p = 0.001) as well as 12 months (p < 0.001) in the rituximab + dexamethasone group. In addition, the incidences of AEs (p = 0.008) were also higher in the rituximab + dexamethasone group. Dexamethasone was superior to prednisone based on OR (p = 0.006). We found no differences in SR at 6 months between dexamethasone and prednisone but SR at 12 months was higher in the dexamethasone group (p = 0.014). The relapse rate was higher in the high dose dexamethasone group compared to the rituximab + dexamethasone group (p = 0.042). Conclusion: This demonstrated that new treatment options such as Rituximab + dexamethasone, could be a good alternative to traditional therapy in improving long-term response and reducing the rate of relapse. However, further studies are required on the increased risk of AEs associated with Rituximab + dexamethasone.

Keywords: clinical trials; dexamethasone; immune thrombocytopenia; prednisone; rituximab.

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Conflict of interest statement

The authors declare that the research wasconducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of study screening and selection process. aThe most updated report was included.
Figure 2
Figure 2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figure 3
Figure 3
Funnel plot and Egger's test and sensitivity analysis. (A) DXM vs. PNS Funnel plot and Egger's test. (B) DXM vs. RTX+DXM Funnel plot and Egger's test. (C) DXM vs. PNS sensitivity analysis. (D) DXM vs. RTX + DXM sensitivity analysis.
Figure 4
Figure 4
Forest map of OR or SR. (A) DXM vs. PNS's OR. (B) DXM vs. PNS's SR (6 month). (C) DXM vs. PNS's SR (12 month). (D) DXM vs. RTX + DXM's OR. (E) DXM vs. RTX + DXM's SR (6 month). (F) DXM vs. RTX+DXM's SR (12 month).
Figure 5
Figure 5
Forest map of AEs or Relapse and bar of AEs. (A) DXM vs. PNS's AEs. (B) DXM vs. PNS's Relapse. (C) DXM vs. RTX + DXM's AEs. (D) DXM vs. RTX + DXM's Relapse. (E) AEs of DXM vs. PNS. (F) AEs of DXM vs. RTX + DXM.
See this image and copyright information in PMC

References

    1. Imbach P, Crowther M. Thrombopoietin-receptor agonists for primary immune thrombocytopenia. N Engl J Med. (2011) 365:734–41. 10.1056/NEJMct1014202 - DOI - PubMed
    1. Zufferey A, Kapur R, Semple JW. Pathogenesis and therapeutic mechanisms in immune thrombocytopenia (ITP). J Clin Med. (2017) 6:16. 10.3390/jcm6020016 - DOI - PMC - PubMed
    1. Chugh S, Darvish-Kazem S, Lim W, Crowther MA, Ghanima W, Wang G, et al. . Rituximab plus standard of care for treatment of primary immune thrombocytopenia: a systematic review and meta-analysis. Lancet Haematol. (2015) 2:e75–81. 10.1016/S2352-3026(15)00003-4 - DOI - PubMed
    1. Cooper N, Ghanima W. Immune thrombocytopenia. N Engl J Med. (2019) 381:945–55. 10.1056/NEJMcp1810479 - DOI - PubMed
    1. Witkowski M, Witkowska M, Robak T. Autoimmune thrombocytopenia: current treatment options in adults with a focus on novel drugs. Eur J Haematol. (2019) 102:447–56. 10.1111/ejh.13319 - DOI - PubMed

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