Romiplostim in adults with newly diagnosed or persistent immune thrombocytopenia.

Abstract

Introduction: Three distinct phases are recognized in immune thrombocytopenia (ITP): newly diagnosed (≤3 months after diagnosis), persistent (>3-12 months after diagnosis), and chronic (>12 months). Several international guidelines/expert recommendations have been released in the past 2 years regarding the treatment of newly diagnosed/persistent ITP. Areas covered: Across the guidelines/expert recommendations, thrombopoietin receptor agonists (TPO-RAs), including romiplostim (the focus of this review), are recommended in newly diagnosed or persistent ITP for patients who fail to respond to corticosteroids or intravenous immunoglobulin (or where these are contraindicated). To identify data relating to romiplostim in adults with newly diagnosed or persistent ITP, we conducted a search of PubMed (with no time limit applied) and abstracts from 2019 EHA/ASH meetings using the term 'romiplostim.' Expert opinion: The findings from nine clinical trials, six real-world studies and ten case reports provide insight into the early use of romiplostim, which could help to reduce exposure to the adverse effects associated with prolonged corticosteroid use, as well as reduce the risk of severe bleeding. Additionally, given the durable responses observed in patients with newly diagnosed/persistent ITP, as well as the potential for treatment-free responses following discontinuation, romiplostim might help to avoid the need for subsequent treatment.

• Authors: Maria L Lozano, Bertrand Godeau, John Grainger, Axel Matzdorff, Francesco Rodeghiero, Jane Hippenmeyer, David J Kuter
• Journal: Expert review of hematology (Expert Rev Hematol) Vol. 13 Issue 12 Pg. 1319-1332 (12 2020) ISSN: 1747-4094 [Electronic] England
• PMID: 33249935 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Adrenal Cortex Hormones
• Antibodies, Neutralizing
• Immunoglobulins, Intravenous
• RHO(D) antibody
• Receptors, Fc
• Receptors, Thrombopoietin
• Recombinant Fusion Proteins
• Rho(D) Immune Globulin
• MPL protein, human
• Rituximab
• Thrombopoietin
• romiplostim

Topics

• Adrenal Cortex Hormones (therapeutic use)
• Adult
• Antibodies, Neutralizing (blood)
• Clinical Trials as Topic
• Combined Modality Therapy
• Drug Resistance
• Humans
• Immunoglobulins, Intravenous (therapeutic use)
• Multicenter Studies as Topic
• Observational Studies as Topic
• Practice Guidelines as Topic
• Purpura, Thrombocytopenic, Idiopathic (drug therapy, immunology, surgery)
• Receptors, Fc (immunology, therapeutic use)
• Receptors, Thrombopoietin (agonists)
• Recombinant Fusion Proteins (adverse effects, immunology, therapeutic use)
• Rho(D) Immune Globulin (therapeutic use)
• Rituximab (therapeutic use)
• Splenectomy
• Thrombopoietin (adverse effects, immunology, therapeutic use)
• Treatment Outcome
• Watchful Waiting