{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T12:58:23Z","timestamp":1790773103636,"version":"4.1.0"},"reference-count":44,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2019,8,18]],"date-time":"2019-08-18T00:00:00Z","timestamp":1566086400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Br J Haematol"],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    Persistent immune thrombocytopenia (ITP) patients require second\u2010line treatments, for which information on clinical outcomes are lacking. A systematic review and network meta\u2010analysis (NMA) were conducted. Only randomised controlled trials (RCT) of second\u2010line drugs in adult persistent ITP patients with platelet response, platelet count, any bleeding or serious adverse events (SAE) outcome were eligible. Twelve RCTs (\n                    <jats:italic>n<\/jats:italic>\n                    \u00a0=\u00a01313) were included in NMA. For platelet response outcome, eltrombopag and romiplostin were the best relative to placebo; the former had a non\u2010significant advantage [risk ratio (RR)\u00a0=\u00a01\u00b710 (95% confidence interval: 0\u00b746, 2\u00b767)]. Both treatments were superior to rituximab and recombinant human thrombopoietin (rhTPO)+rituximab, with corresponding RRs of 4\u00b756 (1\u00b789, 10\u00b796) and 4\u00b718 (1\u00b721, 14\u00b749) for eltrombopag; 4\u00b713 (1\u00b756, 10\u00b794) and 3\u00b779 (1\u00b702, 14\u00b709) for romiplostim. For platelet count, romiplostim ranked highest, followed by eltrombopag, rhTPO+rituximab, and rituximab. For bleeding, rituximab had lowest risk, followed by eltrombopag and romiplostim. For SAEs, rhTPO+rituximab had highest risk, followed by rituximab, eltrombopag and romiplostim. From clustered ranking, romiplostim had the best balance between short\u2010term efficacy and SAEs, followed by eltrombopag. In conclusion, romiplostim and eltrombopag may yield high efficacy and safety. Rituximab may not be beneficial due to lower efficacy and higher complications compared with the thrombopoietin receptor agonists. RCTs with long\u2010term clinical outcomes are required.\n                  <\/jats:p>","DOI":"10.1111\/bjh.16161","type":"journal-article","created":{"date-parts":[[2019,8,18]],"date-time":"2019-08-18T20:13:22Z","timestamp":1566159202000},"page":"450-459","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Treatment efficacy for adult persistent immune thrombocytopenia: a systematic review and network meta\u2010analysis"],"prefix":"10.1111","volume":"188","author":[{"given":"Teeraya","family":"Puavilai","sequence":"first","affiliation":[{"name":"Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand"},{"name":"Division of Hematology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6324-2312","authenticated-orcid":false,"given":"Kunlawat","family":"Thadanipon","sequence":"additional","affiliation":[{"name":"Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasivimol","family":"Rattanasiri","sequence":"additional","affiliation":[{"name":"Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atiporn","family":"Ingsathit","sequence":"additional","affiliation":[{"name":"Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"McEvoy","sequence":"additional","affiliation":[{"name":"Centre for Clinical Epidemiology &amp; Biostatistics Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle New Lambton NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Attia","sequence":"additional","affiliation":[{"name":"Centre for Clinical Epidemiology &amp; Biostatistics Hunter Medical Research Institute, School of Medicine and Public Health, University of Newcastle New Lambton NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ammarin","family":"Thakkinstian","sequence":"additional","affiliation":[{"name":"Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,8,18]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/09537104.2018.1543864"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-08-374777"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.20276"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa054626"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa073275"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60402-5"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2013-07-514398"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.25301"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0076654"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60959-2"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(15)00003-4"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.14515"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2006.06024.x"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0266462312000414"},{"key":"e_1_2_8_16_1","doi-asserted-by":"crossref","first-page":"4145","DOI":"10.3760\/cma.j.issn.0366-6999.20131116","article-title":"Recombinant human thrombopoietin in combination with cyclosporin A as a novel therapy in corticosteroid\u2010resistant primary immune thrombocytopenia","volume":"126","author":"Cui Z.G.","year":"2013","journal-title":"Chinese Medical Journal"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/1076029616663849"},{"key":"e_1_2_8_18_1","first-page":"918","article-title":"Rituximab should be used earlier in ITP patients: a meta\u2010analysis of randomized controlled trials","volume":"9","author":"Feng R.","year":"2016","journal-title":"International Journal of Clinical and Experimental Medicine"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2011-12-309153"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61495-1"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/2042098618769587"},{"key":"e_1_2_8_22_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011)","author":"Higgins J.","year":"2011"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1044"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2385"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1188"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60203-2"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1002625"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/MAJ.0b013e31827f4dd1"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-05-578336"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2010-08-302984"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.24310"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1091"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2009-06-225565"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-07-162503"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12185-011-0886-8"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.4065\/79.4.504"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0258(19991030)18:20<2693::AID-SIM235>3.0.CO;2-V"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2010.08412.x"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2012.04695.x"},{"key":"e_1_2_8_40_1","first-page":"99","article-title":"Long\u2010term safety and efficacy of romiplostim for treatment of immune thrombocytopenia","volume":"7","author":"Vishnu P.","year":"2016","journal-title":"Journal of Blood Medicine"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12185-012-1124-8"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep39003"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.14380"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0198504"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2014-06-581868"}],"container-title":["British Journal of Haematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fbjh.16161","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bjh.16161","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/bjh.16161","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/bjh.16161","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,22]],"date-time":"2024-07-22T00:30:23Z","timestamp":1721608223000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/bjh.16161"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,18]]},"references-count":44,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2020,2]]}},"alternative-id":["10.1111\/bjh.16161"],"URL":"https:\/\/doi.org\/10.1111\/bjh.16161","archive":["Portico"],"relation":{},"ISSN":["0007-1048","1365-2141"],"issn-type":[{"value":"0007-1048","type":"print"},{"value":"1365-2141","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,18]]},"assertion":[{"value":"2019-03-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-06-25","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-08-18","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}