title: Efficacy and safety of eltrombopag in adult refractory immune thrombocytopenia.
abstract: BACKGROUND
  Eltrombopag is a thrombopoietin receptor agonist with excellent treatment outcomes in immune thrombocytopenia (ITP). Here, we analyzed the dose of eltrombopag required to achieve and maintain safe platelet counts in Korean ITP patients.
  
  
  METHODS
  Adult refractory ITP patients (<30,000 platelets/µL) were enrolled. Eltrombopag doses were increased to achieve a target platelet count (≥50,000 cells/µL). After achieving the target platelet count, the dose of concomitant ITP medications and eltrombopag was reduced to identify the lowest effective dose required to maintain the platelet count.
  
  
  RESULTS
  Among 18 patients, 66.7% achieved complete response, 5.6% achieved platelet counts between 50,000 and 100,000 cells/µL, and 27.8% failed to achieve the target platelet count. The median ITP duration was significantly shorter in patients who achieved the target platelet count. The initial dose required to achieve the target platelet count was 25 mg/d. The adjusted maintenance doses were 25 mg twice per week or 25 mg/d. After discontinuation, 83.3% relapsed, and the median relapse-free survival was 15 days. Two relapsed and 1 failed patient switched to romiplostim. The response to romiplostim was similar to eltrombopag. During eltrombopag treatment, 38.9% showed hepatobiliary laboratory anomalies. Among 9 follow-up bone marrow examinations, 1 revealed fibrosis after 1 year of treatment.
  
  
  CONCLUSIONS
  Eltrombopag was well tolerated with excellent treatment outcomes in refractory adult ITP patients. Low-dose eltrombopag effectively maintained the target platelet count. However, some patients required longer or higher-dose treatment to maintain the target platelet count, especially in heavily pretreated or longer ITP cases.
authors.affiliation: Department of Hematology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
authors.forename: Yeo-Kyeoung
authors.initials: YK
authors.lastname: Kim
authors.affiliation: Department of Hematology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
authors.forename: Seung-Sin
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Department of Hematology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
authors.forename: Sung-Hoon
authors.initials: SH
authors.lastname: Jeong
authors.affiliation: Department of Hematology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
authors.forename: Jae-Sook
authors.initials: JS
authors.lastname: Ahn
authors.affiliation: Department of Hematology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
authors.forename: Deok-Hwan
authors.initials: DH
authors.lastname: Yang
authors.affiliation: Department of Hematology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
authors.forename: Je-Jung
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Department of Hematology, Chonnam National University Hwasun Hospital, Hwasun, Korea.
authors.forename: Hyeoung-Joon
authors.initials: HJ
authors.lastname: Kim
keywords: Eltrombopag; Immune thrombocytopenic purpura; Platelets; Romiplostim
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