Efficacy and safety of thrombopoietin receptor agonists in solid tumors with chemotherapy-induced thrombocytopenia: a meta-analysis.

IF 2.8 3区医学 Q2 PHARMACOLOGY & PHARMACY

BMC Pharmacology & Toxicology Pub Date : 2023-12-01 DOI:10.1186/s40360-023-00707-5

Wen Chen, Yubingxue Liu, Luchun Li, Xianghua Zeng

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引用次数: 0

Abstract

Objective: To evaluate the efficacy and safety of thrombopoietin receptor agonists (TPO-RAs) in solid tumors with chemotherapy-induced thrombocytopenia (CIT).

Methods: We conducted a comprehensive search of PubMed, FMRS, Cochrane Library, Web of Science, EMBASE, and ClinicalTrials.gov for randomized controlled trials (RCTs) reporting the efficacy and safety of TPO-RAs in solid tumors with CIT. The search was limited to articles published before April 30, 2022. Primary outcomes included chemotherapy dose reduction or delays, platelet transfusion, the incidence of grade 3 or 4 thrombocytopenia, and bleeding events. Secondary outcomes encompassed the incidence of platelet count > 400 × 10⁹/L, adverse events (AEs), serious AEs, thrombosis, and mortality.

Results: Our analysis encompassed six studies: five rigorous RCTs and one unique study comparing romiplostim to an observation group, involving a total of 489 patients. For primary outcomes, TPO-RAs significantly reduced the incidence of grade 3 or 4 thrombocytopenia (RR = 0.69, 95% CI: 0.52-0.91). After applying the Bonferroni correction for multiple comparisons, the significance of the reduction in grade 3 or 4 thrombocytopenia incidence persisted (P = 0.008). TPO-RAs showed no significant impact on chemotherapy dose reduction or delays (RR = 0.81, 95% CI: 0.65-1.01), platelet transfusion (RR = 1.04, 95% CI: 0.48-2.27), or bleeding events (RR = 0.50, 95% CI: 0.23-1.10). In terms of safety, there were no significant difference in the incidence of any AEs (RR = 0.98, 95% CI:0.92-1.04), serious AEs (RR = 0.79, 95% CI:0.45-1.40), thrombotic events (RR = 1.20, 95% CI:0.51-2.84) and mortality (RR = 1.15, 95% CI:0.55-2.41).

Conclusions: This meta-analysis suggests that TPO-RAs are generally well-tolerated. However, their efficacy in solid tumors with CIT appears limited, as they only demonstrate a reduction in the incidence of grade 3 or 4 thrombocytopenia.

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血小板生成素受体激动剂治疗化疗引起的血小板减少症实体瘤的疗效和安全性:一项荟萃分析。

目的:评价血小板生成素受体激动剂(TPO-RAs)治疗化疗性血小板减少症(CIT)实体瘤的疗效和安全性。方法:我们综合检索PubMed、FMRS、Cochrane Library、Web of Science、EMBASE和ClinicalTrials.gov，检索报道TPO-RAs治疗CIT实体瘤疗效和安全性的随机对照试验(rct)，检索限于2022年4月30日之前发表的文章。主要结局包括化疗剂量减少或延迟、血小板输注、3级或4级血小板减少的发生率和出血事件。次要结局包括血小板计数> 400 × 109/L的发生率、不良事件(ae)、严重ae、血栓形成和死亡率。结果:我们的分析包括六项研究:五项严格的随机对照试验和一项比较romiplostim与观察组的独特研究，共涉及489名患者。对于主要结局，TPO-RAs显著降低了3级或4级血小板减少症的发生率(RR = 0.69, 95% CI: 0.52-0.91)。在应用Bonferroni校正进行多次比较后，3级或4级血小板减少发生率降低的意义仍然存在(P = 0.008)。TPO-RAs对化疗剂量减少或延迟(RR = 0.81, 95% CI: 0.65-1.01)、血小板输注(RR = 1.04, 95% CI: 0.48-2.27)或出血事件(RR = 0.50, 95% CI: 0.23-1.10)无显著影响。在安全性方面，任何不良事件(RR = 0.98, 95% CI:0.92-1.04)、严重不良事件(RR = 0.79, 95% CI:0.45-1.40)、血栓形成事件(RR = 1.20, 95% CI:0.51-2.84)和死亡率(RR = 1.15, 95% CI:0.55-2.41)的发生率无显著差异。结论:该荟萃分析表明TPO-RAs通常耐受良好。然而，它们对CIT实体瘤的疗效似乎有限，因为它们仅能降低3级或4级血小板减少症的发生率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMC Pharmacology & Toxicology PHARMACOLOGY & PHARMACYTOXICOLOGY&nb-TOXICOLOGY

CiteScore

4.80

自引率

0.00%

发文量

审稿时长

12 weeks

期刊介绍： BMC Pharmacology and Toxicology is an open access, peer-reviewed journal that considers articles on all aspects of chemically defined therapeutic and toxic agents. The journal welcomes submissions from all fields of experimental and clinical pharmacology including clinical trials and toxicology.