title: Use of a thrombopoietin mimetic for chronic immune thrombocytopenic purpura in pregnancy.
abstract: BACKGROUND
  Romiplostim, a thrombopoietin mimetic, is a novel therapeutic option for patients with chronic immune thrombocytopenic purpura. We report on the effects of romiplostim use throughout pregnancy.
  
  
  METHODS
  A 28-year-old primigravid woman with chronic immune thrombocytopenic purpura initiated a planned pregnancy on romiplostim. The second and third trimesters were marked by a cyclic pattern of thrombocytopenia requiring supplemental corticosteroids or intravenous immunoglobulin and resultant thrombocytosis. Increased romiplostim doses and daily corticosteroids stabilized the platelet count before induction of labor at 33 weeks of gestation. The newborn manifested intraventricular hemorrhage at birth, although no developmental delay was present on follow-up at 10 months of age.
  
  
  CONCLUSIONS
  The decreased efficacy of romiplostim monotherapy is attributed to increased target-mediated drug disposition and the physiologic changes of pregnancy. Safety concerns still exist for the developmental effects of romiplostim on the fetus.
authors.affiliation: Departments of Obstetrics & Gynecology and Medicine, Duke University Medical Center, Durham, North Carolina; and the Department of Obstetrics & Gynecology, University of Virginia, Charlottesville, Virginia.
authors.forename: Avinash S
authors.initials: AS
authors.lastname: Patil
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Dotters-Katz
authors.forename: Ara D
authors.initials: AD
authors.lastname: Metjian
authors.forename: Andra H
authors.initials: AH
authors.lastname: James
authors.forename: Geeta K
authors.initials: GK
authors.lastname: Swamy
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy*; D011961:Receptors, Fc / Q000627:therapeutic use*; D053628:Receptors, Thrombopoietin / Q000819:agonists; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D013926:Thrombopoietin / Q000627:therapeutic use*
chemical_list: D011961:Receptors, Fc; D053628:Receptors, Thrombopoietin; D011993:Recombinant Fusion Proteins; D013926:Thrombopoietin; C488777:romiplostim