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Nonetheless, the performance of luspatercept outside of controlled clinical trials remains unclear. We aimed to synthesize real\u2010world evidence (RWE) on the effectiveness and safety of luspatercept. This study was conducted following PRISMA guidelines. We searched for studies up to June 2025 evaluating luspatercept in adult MDS patients. Data on hematologic improvement\u2010erythroid (HI\u2010E), transfusion independence (TI at 8, 12, and 16\u00a0weeks), adverse events, and overall survival (OS) were extracted. Bayesian random\u2010effects meta\u2010analyses were performed using priors derived from pooled clinical trials. Seventeen studies were included: five clinical trials (440 patients) and twelve real\u2010world cohorts (1821 patients). The pooled estimate for HI\u2010E was 46.6% (95% CrI: 32.5%\u201363.9%). For TI, pooled rates at 8, 12, and 16\u00a0weeks were 44.7% (95% CrI: 28.6%\u201361.5%), 38.6% (95% CrI: 21.1%\u201360.0%), and 30.9% (95% CrI: 10.7%\u201353.9%), respectively. The subgroups with highest TI and HI\u2010E were patients with positive SF3B1 status (58.5%, at 8\u00a0weeks) and Asian patients (54.8%), respectively. Male sex was associated with lower HI\u2010E, 8, and 12\u00a0weeks TI rates. Hypertension and falls were more frequently reported in RWE. We estimated OS rates of 88.9% at 1\u00a0year and 74.4% at 2\u00a0years following treatment initiation. Real\u2010world HI\u2010E were modestly attenuated, likely reflecting selection, adherence, and monitoring differences. The response seems dependent on disease, geographical, and demographical moderators. Such aspects should be taken into account in the design of future studies and in clinical decisions.<\/jats:p>","DOI":"10.1002\/hon.70226","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T05:44:13Z","timestamp":1784180653000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real\u2010World Luspatercept Evidence in Myelodysplastic Neoplasms: A Systematic Review and Bayesian Meta\u2010Analysis"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9049-0996","authenticated-orcid":false,"given":"Pedro Robson Costa","family":"Passos","sequence":"first","affiliation":[{"name":"Center of Research and Drug Development (NPDM) Federal University of Ceara  Fortaleza Ceara Brazil"},{"name":"Cancer Cytogenomics Laboratory Federal University of Ceara  Fortaleza Ceara Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valbert Oliveira 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