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◎文／藥學生林佳縈、指導藥師林韋綺
2022年的系統性文獻回顧和統合分析研究納入現有的臨床試驗、觀察性研究和回顧性病例系列研究，評估第一代和第二代促血小板生成藥物（thrombopoietic
agents）用在CIT的療效和安全性。
終點包括化療劑量延遲和/或減少、3/4級血小板減少、血小板輸注、≥ 2 級出血和血栓。
研究評估138篇文章後，從其中39篇文章（2,404位病人）中提取數據，並比較促血小板生成藥物組與對照組（對照藥、安慰劑或不治療）的研究數據的隨機效應統合分析，評估的藥品包含14篇重組人類血小板生成素（rhTPO）、7篇巨核細胞生長發育因子（PEG-rHuMGDF）、9篇romiplostim、8篇eltrombopag和1篇romiplostim/eltrombopag。
療效方面，化療劑量延遲和/或減少的統合分析在促血小板生成藥物組納入9項研究和對照組4項研究。與安慰劑或無治療組相比，促血小板生成藥物組並未顯著減少劑量延遲和/或減少（21.1%
[95% CI: 10.8%, 37.0%] I2=89.3% vs 40.4% [95% CI: 9.6%,
81.2%] I2=91.0%，p = 0.364）。3/4級血小板減少症的統合分析在促血小板生成藥物組納入10
項研究和對照組6項研究。促血小板生成藥物組和安慰劑組或無治療組的3/4級血小板減少症發生率相似（39.3% [95% CI:
26.0%, 54.5%] I2=84.4% vs 34.8% [95% CI: 13.0%, 65.7%] I2=82.7%，p
= 0.789），未達統計顯著差異。
（待續）
參考資料：
1.Jaime L Shaw1, Carrie M Nielson1, Joseph K Park1, Andrea
Marongiu2, Gerald A Soff3 The incidence of thrombocytopenia in adult
patients receiving chemotherapy for solid tumors or hematologic
malignancies. Eur J Haematol. 2021 Feb 16;106(5):662–672. doi:
10.1111/ejh.13595.
2.Ying Wu1, Suresh Aravind, Gayatri Ranganathan, Amber Martin, Luba
Nalysnyk Anemia and thrombocytopenia in patients undergoing
chemotherapy for solid tumors: a descriptive study of a large
outpatient oncology practice database, 2000-2007. Clin Ther. 2009:31
Pt 2:2416-32.doi: 10.1016/j.clinthera.2009.11.020.
3. Soff, G. A., Ray-Coquard, I., Rivera, L. J. M., Fryzek, J.,
Mullins, M., Bylsma, L. C., & Park, J. K. (2022). Systematic
literature review and meta-analysis on use of Thrombopoietic agents
for chemotherapy-induced thrombocytopenia. PLOS ONE, 17(6),
e0257673.
4. Wilkins, C. R., Ortiz, J., Gilbert, L. J., Yin, S., Mones, J. V.,
Parameswaran, R., Mantha, S., & Soff, G. A. (2022). Romiplostim for
chemotherapy‐induced thrombocytopenia: Efficacy and safety of
extended use. Research and Practice in Thrombosis and Haemostasis,
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5. Winer, E. S., Safran, H., Karaszewska, B., Bauer, S., Khan, D.,
Doerfel, S., Burgess, P., Kalambakas, S., Mostafa Kamel, Y., &
Forget, F. (2017). Eltrombopag for thrombocytopenia in patients with
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（本文作者為國立陽明交通大學藥學系學生、指導藥師為台北榮民總醫院藥學部藥師）
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