title: 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.affiliation: Department of Haematology, IBSAL-Hospital Universitario de Salamanca, Salamanca, Spain.
authors.forename: José Ramón
authors.initials: JR
authors.lastname: González-Porras
authors.forename: María Eva
authors.initials: ME
authors.lastname: Mingot-Castellano
authors.forename: Marcio M
authors.initials: MM
authors.lastname: Andrade
authors.forename: Rafael
authors.initials: R
authors.lastname: Alonso
authors.forename: Isabel
authors.initials: I
authors.lastname: Caparrós
authors.forename: María Carmen
authors.initials: MC
authors.lastname: Arratibel
authors.forename: Fernando
authors.initials: F
authors.lastname: Fernández-Fuertes
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Cortti
authors.forename: Cristina
authors.initials: C
authors.lastname: Pascual
authors.forename: Blanca
authors.initials: B
authors.lastname: Sánchez-González
authors.forename: Silvia
authors.initials: S
authors.lastname: Bernat
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Fuertes-Palacio
authors.forename: Juan Andrés
authors.initials: JA
authors.lastname: Vázquez-Paganini
authors.forename: Pavel E
authors.initials: PE
authors.lastname: Olivera
authors.forename: María Teresa
authors.initials: MT
authors.lastname: Alvarez-Román
authors.forename: Isidro
authors.initials: I
authors.lastname: Jarque
authors.forename: Montserrat
authors.initials: M
authors.lastname: Cortés
authors.forename: Violeta
authors.initials: V
authors.lastname: Martínez-Robles
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Díaz-Gálvez
authors.forename: María
authors.initials: M
authors.lastname: Calbacho
authors.forename: Carmen
authors.initials: C
authors.lastname: Fernández-Miñano
authors.forename: Javier
authors.initials: J
authors.lastname: Garcia-Frade
authors.forename: Tomás José
authors.initials: TJ
authors.lastname: González-López
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001565:Benzoates / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006834:Hydrazines / Q000008:administration & dosage* / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000188:drug therapy*; D011720:Pyrazoles / Q000008:administration & dosage* / Q000009:adverse effects*; D011961:Receptors, Fc / Q000008:administration & dosage*; D053628:Receptors, Thrombopoietin / Q000819:agonists; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage* / Q000009:adverse effects*; D012189:Retrospective Studies; D013926:Thrombopoietin / Q000008:administration & dosage* / Q000009:adverse effects*
chemical_list: D001565:Benzoates; D006834:Hydrazines; D011720:Pyrazoles; D011961:Receptors, Fc; D053628:Receptors, Thrombopoietin; D011993:Recombinant Fusion Proteins; C082218:MPL protein, human; D013926:Thrombopoietin; C488777:romiplostim; C520809:eltrombopag
keywords: efficacy; eltrombopag; immune thrombocytopenia; romiplostim; switching