Use of eltrombopag after romiplostim in primary immune thrombocytopenia.

Abstract

The thrombopoietin receptor agonists (THPO-RAs), romiplostim and eltrombopag, are effective and safe in immune thrombocytopenia (ITP). However, the value of their sequential use when no response is achieved or when adverse events occur with one THPO-RA has not been clearly established. Here we retrospectively evaluated 51 primary ITP adult patients treated with romiplostim followed by eltrombopag. The median age of our cohort was 49 (range, 18-83) years. There were 32 women and 19 men. The median duration of romiplostim use before switching to eltrombopag was 12 (interquartile range 5-21) months. The reasons for switching were: lack of efficacy (n = 25), patient preference (n = 16), platelet-count fluctuation (n = 6) and side-effects (n = 4). The response rate to eltrombopag was 80% (41/51), including 67% (n = 35) complete responses. After a median follow-up of 14 months, 31 patients maintained their response. Efficacy was maintained after switching in all patients in the patient preference, platelet-count fluctuation and side-effect groups. 33% of patients experienced one or more adverse events during treatment with eltrombopag. We consider the use of eltrombopag after romiplostim for treating ITP to be effective and safe. Response to eltrombopag was related to the cause of romiplostim discontinuation.

• Authors: José Ramón González-Porras, María Eva Mingot-Castellano, Marcio M Andrade, Rafael Alonso, Isabel Caparrós, María Carmen Arratibel, Fernando Fernández-Fuertes, Maria José Cortti, Cristina Pascual, Blanca Sánchez-González, Silvia Bernat, Miguel Angel Fuertes-Palacio, Juan Andrés Vázquez-Paganini, Pavel E Olivera, María Teresa Alvarez-Román, Isidro Jarque, Montserrat Cortés, Violeta Martínez-Robles, Francisco Javier Díaz-Gálvez, María Calbacho, Carmen Fernández-Miñano, Javier Garcia-Frade, Tomás José González-López
• Journal: British journal of haematology (Br J Haematol) Vol. 169 Issue 1 Pg. 111-6 (Apr 2015) ISSN: 1365-2141 [Electronic] England
• PMID: 25521630 (Publication Type: Clinical Trial, Journal Article, Multicenter Study)
• Copyright: © 2014 John Wiley & Sons Ltd.

Chemical References

• Benzoates
• Hydrazines
• Pyrazoles
• Receptors, Fc
• Receptors, Thrombopoietin
• Recombinant Fusion Proteins
• MPL protein, human
• Thrombopoietin
• romiplostim
• eltrombopag

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Benzoates (administration & dosage, adverse effects)
• Female
• Humans
• Hydrazines (administration & dosage, adverse effects)
• Male
• Middle Aged
• Platelet Count
• Purpura, Thrombocytopenic, Idiopathic (blood, drug therapy)
• Pyrazoles (administration & dosage, adverse effects)
• Receptors, Fc (administration & dosage)
• Receptors, Thrombopoietin (agonists)
• Recombinant Fusion Proteins (administration & dosage, adverse effects)
• Retrospective Studies
• Thrombopoietin (administration & dosage, adverse effects)