Comparative Efficacy and Safety of Bruton Tyrosine Kinase and Spleen Tyrosine Kinase Inhibitors in Immune Thrombocytopenia: A Network Meta-Analysis of Clinical Trials.
4 affiliations
- 1Faculty of Medicine Al-Quds University Jerusalem Palestine.
- 2Faculty of Medicine An-Najah University Nablus Palestine.
- 3Deaconess Health System Evansville Indiana USA.
- 4Indiana University School of Medicine Indianapolis Indiana USA.
Abstract
Introduction
Targeted kinase inhibitors have shown statistically and clinically significant improvements in platelet response among patients with primary ITP, supporting their utility as effective targeted therapeutic strategies. We evaluated the efficacy and safety of Bruton tyrosine kinase (BTK) and spleen tyrosine kinase (SYK) inhibitors in primary immune thrombocytopenia (ITP) using network meta-analysis.Methods
Following PRISMA-NMA guidelines, five trials, including 660 patients, were analyzed. Comparing rilzabrutinib, HMPL-523 (sovleplenib), and fostamatinib against placebo. The primary outcome was platelet response (≥ 50 × 10⁹/L), while secondary outcomes included adverse events and treatment discontinuation. Risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a frequentist random-effects model.Results
All treatments significantly improved platelet response versus placebo. Sovleplenib 300 mg showed the greatest efficacy (RR = 30.51, 95% CI: 4.33-214.90), followed by rilzabrutinib 400 mg (RR = 16.60, 95% CI: 2.32-118.92), and fostamatinib 100 mg (RR = 6.51, 95% CI: 1.62-26.08). No significant differences were observed in overall adverse events. Treatment discontinuation risk was lowest with fostamatinib (RR = 1.10, 95% CI: 0.29-4.27).Conclusion
Targeted kinase inhibitors demonstrated clinically meaningful improvements in platelet response in primary ITP, supporting their role as effective targeted therapeutic options. Comparative safety profiles varied, and no clear class-level superiority was established. Therefore, further large head-to-head trials with standardized outcome definitions and longer follow-up durations are needed to confirm long-term efficacy, safety, and consistency of treatment effects across clinical outcomes.Trial registration
The authors have confirmed clinical trial registration is not needed for this submission.
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BibTeX
@article{abulehia2026comparative,
title = {{Comparative Efficacy and Safety of Bruton Tyrosine Kinase and Spleen Tyrosine Kinase Inhibitors in Immune Thrombocytopenia: A Network Meta-Analysis of Clinical Trials.}},
author = {Ayah Abulehia and Raneen Bilal Alshareef and Shorouq Khateeb and Usra Ghanem and Amir Abadi and Nora Zatar and Peter Bael and Raghad Sweity and Hamid Ghanem and Hazem Ayesh},
journal = {EJHaem},
year = {2026},
month = oct,
doi = {10.1002/jha2.70433},
url = {https://europepmc.org/article/MED/42894830},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Comparative Efficacy and Safety of Bruton Tyrosine Kinase and Spleen Tyrosine Kinase Inhibitors in Immune Thrombocytopenia: A Network Meta-Analysis of Clinical Trials.
AU - Ayah Abulehia
AU - Raneen Bilal Alshareef
AU - Shorouq Khateeb
AU - Usra Ghanem
AU - Amir Abadi
AU - Nora Zatar
AU - Peter Bael
AU - Raghad Sweity
AU - Hamid Ghanem
AU - Hazem Ayesh
PY - 2026
DA - 2026/10/18
JO - EJHaem
DO - 10.1002/jha2.70433
UR - https://europepmc.org/article/MED/42894830
AB - Introduction Targeted kinase inhibitors have shown statistically and clinically significant improvements in platelet response among patients with primary ITP, supporting their utility as effective targeted therapeutic strategies. We evaluated the efficacy and safety of Bruton tyrosine kinase (BTK) and spleen tyrosine kinase (SYK) inhibitors in primary immune thrombocytopenia (ITP) using network meta-analysis.Methods Following PRISMA-NMA guidelines, five trials, including 660 patients, were analyzed. Comparing rilzabrutinib, HMPL-523 (sovleplenib), and fostamatinib against placebo. The primary outcome was platelet response (≥ 50 × 10⁹/L), while secondary outcomes included adverse events and treatment discontinuation. Risk ratios (RRs) with 95% confidence intervals (CIs) were estimated using a frequentist random-effects model.Results All treatments significantly improved platelet response versus placebo. Sovleplenib 300 mg showed the greatest efficacy (RR = 30.51, 95% CI: 4.33-214.90), followed by rilzabrutinib 400 mg (RR = 16.60, 95% CI: 2.32-118.92), and fostamatinib 100 mg (RR = 6.51, 95% CI: 1.62-26.08). No significant differences were observed in overall adverse events. Treatment discontinuation risk was lowest with fostamatinib (RR = 1.10, 95% CI: 0.29-4.27).Conclusion Targeted kinase inhibitors demonstrated clinically meaningful improvements in platelet response in primary ITP, supporting their role as effective targeted therapeutic options. Comparative safety profiles varied, and no clear class-level superiority was established. Therefore, further large head-to-head trials with standardized outcome definitions and longer follow-up durations are needed to confirm long-term efficacy, safety, and consistency of treatment effects across clinical outcomes.Trial registration The authors have confirmed clinical trial registration is not needed for this submission.
SN - 2688-6146
ER -