title: A retrospective pilot evaluation of switching thrombopoietic receptor-agonists in immune thrombocytopenia.
abstract: Romiplostim and eltrombopag, the first thrombopoietic receptor-agonists with demonstrated efficacy against immune thrombocytopenia in prospective controlled studies, were recently authorized in most countries for adults with chronic immune thrombocytopenia. So far, no data are available about the potential contribution of switching from romiplostim to eltrombopag or vice versa in terms of efficacy or tolerance. Efficacies and tolerance profiles were evaluated for 46 patients who sequentially received both drugs, switching from one to the other. The reasons for switching were: lack of efficacy for 23 patients, platelet-count fluctuations for 11, side effects for 4, and 8 patients' preferences. For 50-80% of the patients, switching from romiplostim to eltrombopag or eltrombopag to romiplostim effectively impacted the platelet count, with fluctuations disappearing in 54% and side effects resolved in 100%. In 80% of the patients, the 2 thrombopoietic receptor-agonists achieved similar response patterns. Our results confirmed that switching from one thrombopoietic receptor-agonist to the other could be beneficial in clinical practice for patients with severe chronic immune thrombopenia who failed to respond or experienced adverse events to the first. (Clinical Trials.gov identifier: NCT01618734).
authors: Department of Internal Medicine, Centre Hospitalier Universitaire (CHU) Henri-Mondor, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris-Est Créteil (UPEC), Créteil, France.
authors: Mehdi
authors: M
authors: Khellaf
authors: Jean-François
authors: JF
authors: Viallard
authors: Mohamed
authors: M
authors: Hamidou
authors: Stéphane
authors: S
authors: Cheze
authors: Françoise
authors: F
authors: Roudot-Thoraval
authors: François
authors: F
authors: Lefrere
authors: Olivier
authors: O
authors: Fain
authors: Sylvain
authors: S
authors: Audia
authors: Jean-François
authors: JF
authors: Abgrall
authors: Jean-Marie
authors: JM
authors: Michot
authors: Charles
authors: C
authors: Dauriac
authors: Sophie
authors: S
authors: Lefort
authors: Emmanuel
authors: E
authors: Gyan
authors: Mathilde
authors: M
authors: Niault
authors: Jean-Marc
authors: JM
authors: Durand
authors: Laetitia
authors: L
authors: Languille
authors: David
authors: D
authors: Boutboul
authors: Philippe
authors: P
authors: Bierling
authors: Marc
authors: M
authors: Michel
authors: Bertrand
authors: B
authors: Godeau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001565:Benzoates / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D057915:Drug Substitution; D005260:Female; D006801:Humans; D006834:Hydrazines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy*; D011720:Pyrazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011961:Receptors, Fc / Q000008:administration & dosage / Q000627:therapeutic use*; D053628:Receptors, Thrombopoietin / Q000819:agonists*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D013926:Thrombopoietin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D001565:Benzoates; D006834:Hydrazines; D011720:Pyrazoles; D011961:Receptors, Fc; D053628:Receptors, Thrombopoietin; D011993:Recombinant Fusion Proteins; D013926:Thrombopoietin; C488777:romiplostim; C520809:eltrombopag