P1600: USE OF RITUXIMAB PLUS STANDARD OF CARE FOR TREATMENT OF PRIMARY IMMUNE THROMBOCYTOPENIA: A SYSTEMATIC REVIEW AND META-ANALYSIS
Notice bibliographique
Résumé
Topic: 32. Platelet disorders Background: Immune thrombocytopenia (ITP) is a common autoimmune disease associated with decreased platelet counts and increased risk of bleeding. The exact pathophysiology of ITP is still poorly understood, with multiple immune mediated pathways being theorized to contribute. Treatment of this condition is done with the goal of sustained recovery of platelet counts and prevention or cessation of bleeding. If treatment is deemed necessary, first line treatment consists of high dose corticosteroids or intravenous immunoglobulin. Unfortunately for many patients, these treatments produce rapid but transient effects. Rituximab, a monoclonal anti-CD20 antibody, has been shown to improve platelet count response, but evidence for sustained response beyond 6 months is limited. Aims: The objective of this systematic review and meta-analysis is to establish the effect of rituximab on short-term and sustained platelet response in adults with primary ITP. Methods: A comprehensive search of MEDLINE, Embase, and the grey literature was done from inception to September 2022. Studies were screened at abstract and full-text level independently and in duplicate. All English language randomized controlled studies investigating the use of rituximab in addition to standard of care as compared to standard of care were included. Baseline trial characteristics, rituximab dosing regimen, standard of care regimen, and follow up time were collected. Efficacy outcome measures were short-term partial and complete response, and long-term partial and complete response. Partial and complete response were defined by primary study. Short-term was defined as <3 months, whereas long term was defined as >6 months. If multiple time points were presented, longest follow up time was used in analysis. Safety outcomes included bleeding and infection as defined by primary study. Meta-analysis was done using DerSimonioan and Laird random effects model and reported as relative risks (RR) with 95% confidence intervals (CI) Results: Of the 3693 studies screened, five studies with a total of 463 unique patients were included in the analysis. Four trials used standard dosing of rituximab (375 mg/m2), while one trial used low dose rituximab (100 mg). Standard of care in each trial consisted of corticosteroids +- IVIG. Median short-term follow up was 28 days (Range 10 days, 1 month). Median long-term follow up was 12 months (range 6 months, 18 months). Complete response was defined as platelet count >100*109 platelets/L in all studies. Partial response definition varied between >30-50*109 platelets/L. Rituximab is associated with increased short-term partial response (RR 1.34, 95%CI 1.01, 1.77, I2= 68%, N=3), long-term complete response (RR 1.71, 95%CI 1.11, 2.64, I2= 48%, N=4), and long-term partial response (RR 1.58, 95%CI 1.02, 2.44, I2= 74%, N=5). There was insufficient data to analyze short-term complete response. There was no difference between rituximab and standard of care with regards to bleeding (RR 1.06, 95%CI 0.52, 2.13, I2= 3%, N=4). There was a trend towards more infections with rituximab as compared to standard of care (RR 1.41, 95%CI 0.94, 2.14, I2= 0%, N=4). Summary/Conclusion The addition of rituximab may increase both short-term and long-term platelet response rate, with no difference with regards to bleeding as compared to standard of care. There is a trend towards increased infection as compared to standard of care. Evidence regarding sustained response beyond 12 months is limited in this study. Further research including more primary data regarding long-term response and pooled analyses of long-term response are required. Keywords: Immune thrombocytopenia (ITP), Rituximab
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,038 | 0,005 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».