未经证实：免疫性血小板减少症是一种以血小板计数减少为特征的自身免疫性疾病。近年来,在随机对照试验(RCTs)中研究了新的治疗方案.我们旨在比较新诊断的成人原发性免疫性血小板减少症不同治疗方法的疗效和安全性。
UNASSIGNED：我们对新诊断的原发性免疫性血小板减少症的治疗RCTs进行了系统评价和网络荟萃分析。PubMed,Embase,Cochrane中央受控试验登记册,和ClinicalTrials.gov数据库在2022年4月31日之前进行了搜索。主要结果是6个月的持续反应和早期反应。次要结果是3级或更高的不良事件。本研究在PROSPERO（CRD42022296179）注册。
未经评估：本研究包括18项随机对照试验（n=1944）。成对荟萃分析显示，在含地塞米松的双联组中，早期反应的患者百分比高于地塞米松组（79.7％vs68.7％，比值比[OR]1.82，95%CI1.10-3.02)。持续反应的差异更大(60.5%vs37.4%，OR2.57，95%CI1.95-3.40）。网络荟萃分析显示，地塞米松联合重组人血小板生成素在早期反应中排名第一，其次是地塞米松加奥司他韦或他克莫司。利妥昔单抗联合泼尼松龙达到了最高的持续反应，其次是地塞米松加全反式维甲酸或利妥昔单抗。利妥昔单抗加地塞米松显示15.3％的3级或更高的不良事件，其次是prednis（ol）1（4.8％）和全反式维甲酸加地塞米松（4.7％）。
UNASSIGNED：我们的研究结果表明，与单一治疗地塞米松或prednis（ol）1相比，联合治疗方案的早期和持续反应较好.rhTPO加地塞米松在早期反应中排名第一，而利妥昔单抗加皮质类固醇获得了最好的持续反应，但有更多的不良事件。加入奥司他韦,全反式维甲酸或他克莫司对地塞米松达到同样令人鼓舞的持续反应，在不影响安全的情况下。虽然这个网络荟萃分析比较了所有最新的治疗方案，有必要在这些策略之间进行更多的头对头RCT和更大的样本量进行直接比较.
联合国：国家自然科学基金委员会,国家自然科学基金重大研究计划,山东省自然科学基金和山东省青年泰山学者基金会。
UNASSIGNED: Immune thrombocytopenia is an autoimmune disease characterised by decreased platelet count. In recent years, novel therapeutic regimens have been investigated in randomised controlled trials (RCTs). We aimed to compare the efficacy and safety of different treatments in newly diagnosed adult primary immune thrombocytopenia.
UNASSIGNED: We did a systematic review and network meta-analysis of RCTs involving treatments for newly diagnosed primary immune thrombocytopenia. PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched up to April 31, 2022. The primary outcomes were 6-month sustained response and early response. Secondary outcome was grade 3 or higher adverse events. This study is registered with PROSPERO (CRD42022296179).
UNASSIGNED: Eighteen RCTs (n = 1944) were included in this study. Pairwise meta-analysis showed that the percentage of patients achieving early response was higher in the dexamethasone-containing doublet group than in the dexamethasone group (79.7% vs 68.7%, odds ratio [OR] 1.82, 95% CI 1.10-3.02). The difference was more profound for sustained response (60.5% vs 37.4%, OR 2.57, 95% CI 1.95-3.40). Network meta-analysis showed that dexamethasone plus recombinant human thrombopoietin ranked first for early response, followed by dexamethasone plus oseltamivir or tacrolimus. Rituximab plus prednisolone achieved highest sustained response, followed by dexamethasone plus all-trans retinoic acid or rituximab. Rituximab plus dexamethasone showed 15.3% of grade 3 or higher adverse events, followed by prednis(ol)one (4.8%) and all-trans retinoic acid plus dexamethasone (4.7%).
UNASSIGNED: Our findings suggested that compared with monotherapy dexamethasone or prednis(ol)one, the combined regimens had better early and sustained responses. rhTPO plus dexamethasone ranked top in early response, while rituximab plus corticosteroids obtained the best sustained response, but with more adverse events. Adding oseltamivir, all-trans retinoic acid or tacrolimus to dexamethasone reached equally encouraging sustained response, without compromising safety profile. Although this network meta-analysis compared all the therapeutic regimens up to date, more head-to-head RCTs with larger sample size are warranted to make direct comparison among these strategies.
UNASSIGNED: National Natural Science Foundation of
China, Major Research Plan of National Natural Science Foundation of
China, Shandong Provincial Natural Science Foundation and Young Taishan Scholar Foundation of Shandong Province.
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