Thrombopoietin receptor agonists use and risk of thrombotic events in patients with immune thrombocytopenic purpura: A systematic review and meta‑analysis of randomized controlled trials

Shen,Nan; Qiao,Jibing; Jiang,Yazhou; Yan,Jingjing; Wu,Rang; Yin,Hanjun; Zhu,Suyue; Li,Jianqin

doi:10.3892/br.2024.1732

Thrombopoietin receptor agonists use and risk of thrombotic events in patients with immune thrombocytopenic purpura: A systematic review and meta‑analysis of randomized controlled trials

Authors:
- Nan Shen
- Jibing Qiao
- Yazhou Jiang
- Jingjing Yan
- Rang Wu
- Hanjun Yin
- Suyue Zhu
- Jianqin Li
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Affiliations: Department of Pediatrics, Suqian Hospital Affiliated to Xuzhou Medical University, Suqian, Jiangsu 223800, P.R. China, Department of Hematology, The Children's Hospital of Soochow University, Suzhou, Jiangsu 215000, P.R. China
Published online on: January 22, 2024 https://doi.org/10.3892/br.2024.1732
Article Number: 44
Copyright: © Shen et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Thrombopoietin receptor agonists (TPO‑RAs) have a role in second‑line immune thrombocytopenic purpura (ITP) treatment, binding to and activating thrombopoietin receptors on megakaryocyte membranes in the bone marrow. This promotes megakaryocyte maturation and increases platelet production. Despite a 2‑6% incidence of thrombotic events during TPO‑RA treatment, it remains uncertain whether TPO‑RAs elevate thrombosis rates. A comprehensive search of electronic databases was conducted using the relevant search criteria. To assess the risk of bias, the included studies were assessed using the revised Cochrane Risk of Bias Assessment Tool 2.0, and a meta‑analysis was performed using RevMan 5.4.1. A total of 1,698 patients with ITP were included from randomized controlled trials (RCTs). There were 26 thromboembolic events in the TPO‑RAs group and 4 in the control group. However, there was no significant difference in the incidence of thrombotic events between the two groups [odds ratio (OR)=1.76, 95% confidence interval (CI): 0.78‑4.00, P=0.18], even if the duration of treatment was >12 weeks (OR=2.46, 95% CI: 0.81‑7.43, P=0.11). Subgroup analysis showed that none of the four drugs significantly increased the incidence of thrombotic events (romiplostim: OR=0.92, 95% CI: 0.14‑6.13, P=0.93; eltrombopag: OR=2.32, 95% CI: 0.64‑8.47, P=0.20; avatrombopag: OR=4.15, 95% CI: 0.20‑85.23, P=0.36; and hetrombopag: OR=0.76, 95% CI: 0.03‑18.76, P=0.87). There was also no significant difference in the results of the double‑blinded placebo‑controlled RCTs (OR=1.21, 95% CI: 0.41‑3.58, P=0.73). Compared to patients with ITP who did not receive TPO‑RA treatment, those receiving TPO‑RA treatment did not exhibit a significantly increased risk of thrombotic events.

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