The use of cyclosporine-based combination therapy is effective for treating primary immune thrombocytopenia (ITP), according to a meta-analysis published in the Journal of International Medical Research.

In the analysis, cyclosporine-based combination therapy was found to increase platelet counts and improve overall response rate (ORR) and complete response (CR) rate in patients with ITP. Using pooled data from the 4 studies that reported platelet counts, treatment was found to increase the counts by a standard mean difference of 3.92 (95% CI 2.23–5.61; P <0.00001).

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All 7 studies in the meta-analysis reported ORRs and using a fixed-effects model on the pooled data revealed that the ORR was significantly higher in the patients who received cyclosporine-based combination therapy than the control group (odds ratio [OR], 5.55; 95% CI, 2.89–10.68; P <0.00001).

Subgroup analysis based on age showed that the ORR was still significantly increased in the treatment group compared to the control group in both children  (OR  5.74; 95% CI 1.79–18.41; P =.003) and adults (OR 5.46; 95% CI 2.48–12.02; P <0.0001).

The CR rate was reported in 6 of the studies and pooled analysis using a fixed-effects model showed that it was significantly higher in the treatment group than the control group (OR, 2.18; 95% CI, 1.42–3.34; P =.0003). Subgroup analysis showed that it was still higher in both children (OR 1.70; 95% CI 0.95–3.02) and adults (OR 2.97; 95% CI 1.56–5.63; P =.0009), but did not reach significance in children.

The relapse rate was significantly lower in the combination therapy group based on data from the 2 studies which reported relapse rate (OR 0.03; 95% CI 0.01–0.12; P <0.00001). The rate of adverse drug reactions (ADRs) was not found to be significantly different between patients who received cyclosporine-based combination therapy and the control group based on the data from the 3 studies which reported ADRs (OR, .5; 95% CI  0.22–1.25; P =0.15).

“The results of this analysis illustrated that cyclosporine-based combination therapy increased the ORR and CR rate and reduced the relapse rate. Furthermore, cyclosporine-based combination therapy significantly increased the platelet count, and no obvious ADRs were detected,” the study’s authors said.

A total of 7 studies were included in the meta-analysis for a total of 418 patients with ITP including 211 in the cyclosporine-based combination therapy group and 207 in the control group.


Li X, Zhu W, Bao J, Li J, Zhou Y. Efficacy and safety of cyclosporine-based regimens for primary immune thrombocytopenia: a systematic review and meta-analysis. J Int Med Res. Published online January 17, 2023. doi:10.1177/03000605221149870