Abstract Aplastic anaemia (AA) is a rare bone marrow failure disorder with a notably higher incidence in Asian populations, including India. Due to limited access to bone marrow transplantation (BMT) in resource-limited settings, immunosuppressive therapy (IST) remains the mainstay of treatment. However, the optimal combination of available IST regimens in low-resource environments remains uncertain. Therefore, we performed a meta-analysis to evaluate the effectiveness and safety of various immunosuppressive strategies—particularly equine antithymocyte globulin (eATG) combined with cyclosporine A (CSA), with or without eltrombopag (EPAG), as well as CSA and anabolic steroids-based monotherapies, for the treatment of AA in Indian patients. Fifty-nine studies (49 single-arm, 10 multi-arm) from PubMed, Google Scholar, and Indian Society of Haematology OR 0.72, p = 0.12, and OR 0.67, p = 0.23, respectively). Similarly, comparative analysis of dual therapy (eATG + CSA) with triple therapy (eATG + CSA + EPAG) at 6 months showed no significant difference in ORRs (OR 0.67, p = 0.50). In survival analysis, the eATG + CSA and THYMOGAM + CSA demonstrated 5-year OS rates of 74.90% and 73%, respectively. The 5-year EFS rate for eATG + CSA was 63.5%. Common TRAEs included febrile neutropenia and serum sickness. Mortality rates showed no significant differences among different treatments regimens: eATG + CSA vs. ATGAM + CSA (11.31% vs. 6.24%, p = 0.15), THYMOGAM + CSA vs. ATGAM + CSA (13.15% vs. 6.24%, p = 0.17), and eATG + CSA vs. eATG + CSA + anabolic steroids (11.31% vs. 15.03%, p = 0.41). In conclusion, IST remains an effective frontline approach for AA patients in India, especially where transplant options are limited. Regimens incorporating EPAG offer superior response rates, and THYMOGAM presents a cost-effective yet clinically viable alternative to ATGAM. These insights support more tailored, accessible treatment strategies in resource-constrained settings.
George et al. (Thu,) studied this question.