Potential therapeutics for antiphospholipid antibody associated thrombocytopenia: A systematic review and meta-analysis

Abstract

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.

Keywords:

• Antiphospholipid antibody
• meta-analysis
• splenectomy
• systematic review
• thrombocytopenia

Conflicts of interest

Tatsuya Atsumi has received personal fees from Chugai during the conduct of the study; grants and personal fees from Astellas, Takeda, Mitsubishi Tanabe, Chugai, and Pfizer; grants from Daiichi Sankyo and Otsuka; personal fees from Eisai and AbbVie outside the submitted work. The other authors have declared no conflicts of interest.

Acknowledgement

The authors thank Ms. Miwako Segawa, department of clinical epidemiology, National Center for Child Health and Development, for her technical assistance in the electronic literature search.

Additional information

Funding

This work was supported by the Japanese Ministry of Health, Labor and Welfare [grant number 7142000105].