Therapeutic efficacy and safety of pathogen‐reduced platelet components: Results of a meta‐analysis of randomized controlled trials

Abstract Background and Objectives Clinical efficacy and safety of pathogen‐reduced platelet concentrates (PR‐PCs) concerning bleeding prevention are still debated despite conclusive real‐world data from multiple countries where PR‐PCs are transfused routinely. We performed a meta‐analysis of randomized controlled trials (RCTs) comparing the clinical efficacy and safety of conventional platelet components (PCs) and PR‐PCs prepared with the amotosalen/ultraviolet A light (INTERCEPT platelet concentrate [I‐PC]) or riboflavin/ultraviolet light (Mirasol platelet concentrate [M‐PC]) technologies, transfused in thrombocytopenic adult patients. Materials and Methods A literature search was conducted, and 10 RCTs met the criteria for inclusion in this meta‐analysis. Summary odds ratios (ORs) of clinically significant bleeding (World Health Organization [WHO] bleeding grade ≥2), severe bleeding (WHO bleeding score ≥3) and all‐cause mortality were calculated. Results The use of I‐PC was not associated with an increase in the OR of clinically significant bleeding when compared to non‐treated PCs (OR, 1.12; 95% CI: 0.89–1.41; p = 0.33), whereas transfusions with M‐PC showed an increase in clinically significant bleeding (OR, 1.34; 95% CI: 1.03–1.75; p = 0.03). The OR of severe bleeding did not increase with either I‐PC or M‐PC (OR 0.88; 95% CI: 0.59–1.31; p = 0.52 for I‐PC; OR 1.25; 95% CI: 0.66–2.37; p = 0.49 for M‐PC). In the case of all‐cause mortality, compared to non‐treated PC, I‐PC showed an OR of 0.61 (95% CI: 0.36–1.04; p = 0.07), and M‐PC showed an OR of 3.04 (95% CI: 0.81–11.47; p = 0.1). Conclusion No differences were observed concerning the clinical efficacy and safety of overall PR‐PCs when compared to non‐treated PCs. However, differences are evident when analysing platelets prepared with the two PR technologies independently.