title: Case study of remission in adults with immune thrombocytopenia following cessation of treatment with the thrombopoietin mimetic romiplostim.
abstract: OBJECTIVE
  In adults, immune thrombocytopenia (ITP), characterized by platelet counts <100 × 10(9)/l, is typically chronic, with remission reported infrequently ≥3 years post-diagnosis. The thrombopoietin mimetic romiplostim increases platelet counts and reduces use of concomitant ITP medications in chronic ITP. While often perceived as a long-term treatment, dose-adjustment rules allow romiplostim to be discontinued when hemostatic platelet counts are reached, as reported in Amgen trials.
  
  
  METHODS
  Eight romiplostim trials were examined for remission, defined as ≥26 consecutive weeks of platelets ≥50 × 10(9)/l without treatment.
  
  
  RESULTS
  Remission was identified in 27 patients; median (quartile 1 [Q1], quartile 3 [Q3]) ITP duration of 2.1 (0.5, 4.2) years, 17/27 (63%) having ITP for >1 year, mean baseline platelets 20.9 × 10(9)/l, median preremission maximum dose 3.0 µg/kg, 12/27 (44%) were splenectomized at baseline, and there were 40-276 cumulative weeks of romiplostim with median time to remission 7.1 months.
  
  
  CONCLUSIONS
  No clear-cut predictors of remission were apparent; however, a number of patients had ITP for <1 year and received romiplostim for <1 year.
authors.affiliation: a Department of Pediatrics, Division of Hematology , Weill Medical College of Cornell University , New York , NY , USA.
authors.forename: James B
authors.initials: JB
authors.lastname: Bussel
authors.affiliation: b One Amgen Center Drive , Amgen Inc ., Thousand Oaks , CA , USA.
authors.forename: Xuena
authors.initials: X
authors.lastname: Wang
authors.affiliation: b One Amgen Center Drive , Amgen Inc ., Thousand Oaks , CA , USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Lopez
authors.affiliation: b One Amgen Center Drive , Amgen Inc ., Thousand Oaks , CA , USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Eisen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000188:drug therapy*; D011961:Receptors, Fc / Q000008:administration & dosage*; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D012074:Remission Induction; D013926:Thrombopoietin / Q000008:administration & dosage*
chemical_list: D011961:Receptors, Fc; D011993:Recombinant Fusion Proteins; D013926:Thrombopoietin; C488777:romiplostim
keywords: Platelets; Remission; Thrombopoietin; Thrombopoietin receptor agonist