TY - JOUR
T1 - Potential therapeutics for antiphospholipid antibody associated thrombocytopenia
T2 - A systematic review and meta-analysis
AU - Abe, Nobuya
AU - Oku, Kenji
AU - Amengual, Olga
AU - Fujieda, Yuichiro
AU - Kato, Masaru
AU - Bohgaki, Toshiyuki
AU - Yasuda, Shinsuke
AU - Mori, Rintaro
AU - Morishita, Eriko
AU - Suzuki-Inoue, Katsue
AU - Atsumi, Tatsuya
N1 - Publisher Copyright:
© 2019, © 2019 Japan College of Rheumatology.
PY - 2020/1/2
Y1 - 2020/1/2
N2 - Objectives: Thrombocytopenia is frequently observed in antiphospholipid antibody (aPL) carriers. Due to the paradoxical risks of thrombosis and hemorrhage, the management of aPL-associated thrombocytopenia (APAT) is often deductive. We aimed to investigate the efficacy and safety of therapeutic approaches for APAT through a systematic review. Methods: Four therapeutic approaches for APAT, including antiplatelet agents, glucocorticoids, splenectomy and thrombopoietin receptor agonists, were selected. Clinical trials evaluating therapeutic outcomes including the remission, complications, mortality and relapse, were searched in MEDLINE, EMBASE and CENTRAL from the inception dates to 28 November 2016. A meta-analysis was performed to calculate risk ratios (RRs) and 95% confidence intervals (CIs) using random-effects models. Results: Out of 1407 papers, eight controlled clinical trials were included. In patients with APAT, the remission rates were higher in patients on glucocorticoids (RR 8.33 [95% CI 3.07–22.6]) or splenectomy (RR 8.37 [95% CI 1.61–43.7]) than in patients without those treatments. There was no significant association between glucocorticoids and thrombosis (RR 1.57 [95% CI, 0.17–14.9]) or between splenectomy and hemorrhage (RR 0.17 [95% CI 0.02–1.28]). The extracted data of mortality and relapse rate were not available for synthesis. Conclusion: Glucocorticoids or splenectomy seemed suitable therapeutic approaches for APAT.
AB - Objectives: Thrombocytopenia is frequently observed in antiphospholipid antibody (aPL) carriers. Due to the paradoxical risks of thrombosis and hemorrhage, the management of aPL-associated thrombocytopenia (APAT) is often deductive. We aimed to investigate the efficacy and safety of therapeutic approaches for APAT through a systematic review. Methods: Four therapeutic approaches for APAT, including antiplatelet agents, glucocorticoids, splenectomy and thrombopoietin receptor agonists, were selected. Clinical trials evaluating therapeutic outcomes including the remission, complications, mortality and relapse, were searched in MEDLINE, EMBASE and CENTRAL from the inception dates to 28 November 2016. A meta-analysis was performed to calculate risk ratios (RRs) and 95% confidence intervals (CIs) using random-effects models. Results: Out of 1407 papers, eight controlled clinical trials were included. In patients with APAT, the remission rates were higher in patients on glucocorticoids (RR 8.33 [95% CI 3.07–22.6]) or splenectomy (RR 8.37 [95% CI 1.61–43.7]) than in patients without those treatments. There was no significant association between glucocorticoids and thrombosis (RR 1.57 [95% CI, 0.17–14.9]) or between splenectomy and hemorrhage (RR 0.17 [95% CI 0.02–1.28]). The extracted data of mortality and relapse rate were not available for synthesis. Conclusion: Glucocorticoids or splenectomy seemed suitable therapeutic approaches for APAT.
KW - Antiphospholipid antibody
KW - meta-analysis
KW - splenectomy
KW - systematic review
KW - thrombocytopenia
UR - http://www.scopus.com/inward/record.url?scp=85059954926&partnerID=8YFLogxK
U2 - 10.1080/14397595.2018.1558934
DO - 10.1080/14397595.2018.1558934
M3 - 学術論文
C2 - 30557100
AN - SCOPUS:85059954926
SN - 1439-7595
VL - 30
SP - 116
EP - 124
JO - Modern Rheumatology
JF - Modern Rheumatology
IS - 1
ER -