Two cases of thrombosis in patients with antiphospholipid antibodies during treatment of immune thrombocytopenia with romiplostim, a thrombopoietin receptor agonist.
BACKGROUND
Romiplostim is a thrombopeitin-receptor agonist approved for raising platelet counts in patients with immune thrombocytopenia (ITP). Several hematologic adverse effects have been reported including acute myeloid leukemia, myelofibrosis, and thrombosis.


METHODS
We report two cases, one pediatric and one adult patient, who had antiphospholipid antibodies and received romiplostim for ITP. Additionally, we conducted medline, Food and Drug Administration (FDA) Adverse Events reports website, and manufacturer's adverse events database.


RESULTS
Both patients developed thrombosis with evidence for catastrophic antiphospholipid syndrome (CAPS) after treatment with romiplostim. No reports or events were found from literature and database searches in regards to thrombosis associated with romiplostim in patients with antiphospholipid syndrome.


CONCLUSIONS
These cases illustrate the potential for thrombosis with the administration of romiplostim. The administration of this drug to patients with a history of an autoimmune disease, especially those with positive antiphospholipid antibodies, should be done with caution.
Department of Rheumatology, Ohio State Wexner Medical Center, 543 Taylor Ave, Columbus, OH 43210. Electronic address: brian.lamoreaux@osumc.edu.
Brian
B
LaMoreaux
Section of Pediatric Rheumatology, Nationwide Children׳s Hospital, Columbus, OH.
Fatima
F
Barbar-Smiley
Department of Rheumatology, Ohio State Wexner Medical Center, 543 Taylor Ave, Columbus, OH 43210; Section of Pediatric Rheumatology, Nationwide Children׳s Hospital, Columbus, OH.
Stacy
S
Ardoin
Department of Rheumatology, Ohio State Wexner Medical Center, 543 Taylor Ave, Columbus, OH 43210.
Hareth
H
Madhoun
D000293:Adolescent; D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000097:blood*; D001327:Autoimmune Diseases / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D008297:Male; D011961:Receptors, Fc / Q000627:therapeutic use; D053628:Receptors, Thrombopoietin / Q000819:agonists*; D011993:Recombinant Fusion Proteins / Q000009:adverse effects* / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D013926:Thrombopoietin / Q000009:adverse effects* / Q000627:therapeutic use; D013927:Thrombosis / Q000139:chemically induced* / Q000276:immunology
D017152:Antibodies, Antiphospholipid; D011961:Receptors, Fc; D053628:Receptors, Thrombopoietin; D011993:Recombinant Fusion Proteins; D013926:Thrombopoietin; C488777:romiplostim
Antiphospholipid syndrome; Catastrophic antiphospholipid syndrome; Immune thrombocytopenia; Romiplostim