Real‐World Safety and Efficacy of Avatrombopag in Adults with Immune Thrombocytopenia: A Systematic Review and Meta‐Analysis

Objective This systematic review and meta‐analysis aimed to evaluate the risk of thromboembolic events and assess the overall safety and effectiveness of avatrombopag in adult patients with immune thrombocytopenia using real‐world evidence. Methods A systematic search was conducted following the PRISMA 2020 guidelines. Observational studies (2020–2024) on adults with primary immune thrombocytopenia treated with avatrombopag were included. Primary outcomes were thromboembolic complications and treatment response; secondary outcomes included time to response, treatment discontinuation, and adverse events. Random‐effects meta‐analyses were performed to synthesise pooled proportions and rates. Risk of bias was assessed using the ROBINS‐Version 2 tool. Results Fifteen studies were included. The pooled proportion of patients with thromboembolic events was 2.82% (95% confidence interval: 1.61%–4.27%), with an incidence rate of 3.29 per 100 patient‐years (95% CI: 1.81–5.08). Response and complete response were achieved by 80.0% and 92.0% of patients, respectively. The median time to response was 11 days, and the discontinuation rate was 18.9%. Adverse events occurred in 4.1% of patients. Conclusion In real‐world practice, avatrombopag demonstrated high platelet response rates and a low pooled incidence of thrombotic events. These findings add real‐world evidence on avatrombopag outcomes in adult immune thrombocytopenia.