{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T17:48:24Z","timestamp":1790358504812,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,12,28]],"date-time":"2021-12-28T00:00:00Z","timestamp":1640649600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Children with immune thrombocytopenia (ITP) may require second\u2010line ITP therapies. The high remission rate in pediatric patients, need for extended\u2010duration use of thrombopoietin receptor agonists (TPO\u2010RAs), drug adherence, potential side effects, monitoring, and cost effectiveness are factors that should be considered in decision\u2010making about second\u2010line therapies. Rituximab (RTX) has been used off\u2010label for years to treat ITP but there are limited studies about its efficacy and safety in children. To date, no studies have directly compared TPO\u2010RAs with RTX for the treatment of childhood ITP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This systematic review analyzed the overall platelet response, durability of treatment effect, and safety for RTX use in comparison to TPO\u2010RAs in pediatric ITP. MEDLINE\/PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched through December 2020 and meta\u2010analysis was conducted using proportions of success\/failure for each intervention in the selected studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The proportion of participants achieving the primary endpoint of a platelet response above 50,000 was similar for TPO\u2010RAs (proportion\u00a0=\u00a00.71, 95% CI: 0.63\u20130.78) and RTX (proportion\u00a0=\u00a00.68, 95% CI: 0.53\u20130.82). However, considerable variation was found between the two groups with regards to the sustainability of the response and other secondary outcomes such as need for rescue and adverse events. RTX was associated with higher rates of rescue therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this analysis of prospective pediatric ITP studies, RTX and TPO\u2010RAs had similar rates of overall platelet response but differed in other important measures. Prospective comparative studies are needed to better characterize second\u2010line treatments for pediatric ITP.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.29447","type":"journal-article","created":{"date-parts":[[2021,12,28]],"date-time":"2021-12-28T13:59:43Z","timestamp":1640699983000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Thrombopoietin receptor agonists and rituximab for treatment of pediatric immune thrombocytopenia: A systematic review and meta\u2010analysis of prospective clinical trials"],"prefix":"10.1002","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1482-7792","authenticated-orcid":false,"given":"Nardeen","family":"Ayad","sequence":"first","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7302-0449","authenticated-orcid":false,"given":"Rachael F.","family":"Grace","sequence":"additional","affiliation":[{"name":"Dana\u2010Farber\/Boston Children's Cancer and Blood Disorder Center Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6175-1383","authenticated-orcid":false,"given":"Hanny","family":"Al\u2010Samkari","sequence":"additional","affiliation":[{"name":"Division of Hematology, Massachusetts General Hospital Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,12,28]]},"reference":[{"issue":"1","key":"e_1_2_10_2_1","first-page":"636","article-title":"Demonstration of a thrombocytopenic factor in the blood of patients with thrombocytopenic purpura","volume":"38","author":"Harrington WJ","year":"1951","journal-title":"J Lab Clin 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