Efficacy and Safety of Thrombopoietin Receptor Agonist (TPO-RA) in Patients with Chronic Liver Disease: A Systematic Review and Meta-Analysis

Abstract

Context: The TPO-receptor agonist (TPO-RA) has been extensively studied for its use in thrombocytopenia. Objectives: We aimed to systematically analyze the efficacy and safety of TPO-RA in chronic liver disease patients. Methods: The study population consisted of adults with chronic liver disease. The intervention was TPO-RA. The primary outcome was the efficacy of TPO-RA (increase in thrombocyte levels and likelihood of avoiding thrombocyte transfusion pre-operatively), while the secondary outcome was the safety of TPO-RA. The demographics of the study and the usage of TPO-RA medications were used to classify the research. Results: This review consisted of 1529 chronic liver disease patients who received TPO-RA and 911 who received a comparator (placebo or thrombocyte transfusion). The TPO-RA significantly increased thrombocyte levels by 34.59 × 109/L (P < 0.00001). The use of TPO-RA pre-procedure reduced the likelihood of pre-operative platelet transfusion and up to seven days following the scheduled procedure by 88% (P < 0.00001). TPO-receptor agonist was not associated with all-cause mortality (P = 0.77) or an increase in thrombosis events, with a pooled OR of 1.36 (P = 0.43). According to a meta-regression analysis, the population may explain the heterogeneity. Subsequent leave-one-out sensitivity analysis of the thrombocyte level change after TPO-RA revealed that no single study was accountable for the heterogeneity of thrombocyte level changes. Conclusions: The use of TPO-RA increases the thrombocyte levels of chronic liver disease patients and reduces the odds of needing thrombocyte transfusion pre-operatively. TPO-receptor agonist is also safe to use, with no increase in mortality risk or thrombosis risk.