ReviewCureus2025
Effectiveness of Rituximab, Belimumab, and Thrombopoietin Receptor Agonists in Refractory Immune Thrombocytopenia Associated With Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis.
Review in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
3 authors.
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Abstract
Thrombocytopenia is a frequent and clinically significant hematologic manifestation of systemic lupus erythematosus (SLE). A subset of patients develops refractory immune thrombocytopenia (ITP) despite standard therapy, creating a major therapeutic challenge. Targeted agents, including rituximab, belimumab, and thrombopoietin receptor agonists (TPO-RAs), have been used in small studies, but their overall effectiveness in SLE-associated refractory ITP has not been comprehensively evaluated. To systematically review and synthesize evidence on the effectiveness of rituximab, belimumab, and TPO-RAs for refractory ITP in adults with SLE, we conducted a systematic review and meta-analysis of observational studies following a prespecified protocol. Eligible studies included adults with confirmed SLE and refractory ITP treated with rituximab, belimumab, or TPO-RAs. Data were extracted on clinical outcomes, including complete response, partial response, and overall response rate (ORR). A meta-analysis of proportions using fixed-effects models was performed for each treatment category. Methodological quality was assessed using the Newcastle-Ottawa Scale. Eleven studies involving 11 cohorts met the inclusion criteria. Six cohorts (192 patients; pooled ORR 88.5% [170/192]) evaluated rituximab, two cohorts (14 patients; pooled ORR 92.9% [13/14]) evaluated belimumab, and three cohorts (31 patients; pooled ORR 96.8% [30/31]) evaluated TPO-RAs. Rituximab demonstrated a consistently high ORR of 88.5% (170/192) across studies. Belimumab showed an ORR of 92.9% (13/14), although small sample sizes limited evidence. TPO-RAs demonstrated the highest ORR of 96.8% (30/31), with rapid platelet recovery in most patients. Overall study quality was moderate, with larger rituximab cohorts providing the most substantial evidence, whereas belimumab and TPO-RA data were derived from small retrospective studies. Definitions of treatment response varied across studies. Rituximab, belimumab, and TPO-RAs appear to be effective therapeutic options for refractory SLE-associated ITP, with consistently high response rates across available studies. Evidence is strongest for rituximab, while belimumab and TPO-RAs show promising results that require confirmation in larger, well-designed prospective studies. Standardization of response criteria and improved safety reporting are needed to optimize treatment strategies for this challenging clinical condition.
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