A low birth weight infant with no malformations delivered by a primary immune thrombocytopenia patient treated with eltrombopag

Suzuki, Naruko; Hiraga, Junji; Hariyama, Yumi; Takagi, Yusuke; Ohashi, Haruhiko; Kishigami, Yasuyuki; Oguchi, Hidenori

doi:10.1007/s12185-017-2383-1

Cited by 21 publications

(17 citation statements)

References 12 publications

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“…All available published data are from 11 available case reports, and all show a platelet response. [119][120][121]141,[231][232][233][234][235][236][237] Romiplostim and eltrombopag may cross the placenta and could cause potential harm to the fetus. 119,120,227 In the 11 cases reviewed here, there were no safety concerns.…”

Section: Management Of Pregnant Patients With Itp Failing Initial Trementioning

confidence: 99%

“…119,120,227 In the 11 cases reviewed here, there were no safety concerns. [119][120][121]141,[231][232][233][234][235][236][237] TPO-RAs are not recommended except in very serious cases; if used, romiplostim may be preferred given its fewer off-target effects (lack of hepatic toxicity and iron chelation) and limited safety database.…”

Section: Management Of Pregnant Patients With Itp Failing Initial Trementioning

confidence: 99%

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Updated international consensus report on the investigation and management of primary immune thrombocytopenia

et al. 2019

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Over the last decade, there have been numerous developments and changes in treatment practices for the management of patients with immune thrombocytopenia (ITP). This article is an update of the International Consensus Report published in 2010. A critical review was performed to identify all relevant articles published between 2009 and 2018. An expert panel screened, reviewed, and graded the studies and formulated the updated consensus recommendations based on the new data. The final document provides consensus recommendations on the diagnosis and management of ITP in adults, during pregnancy, and in children, as well as quality-of-life considerations.

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Section: Management Of Pregnant Patients With Itp Failing Initial Trementioning

confidence: 99%

Section: Management Of Pregnant Patients With Itp Failing Initial Trementioning

confidence: 99%

Updated international consensus report on the investigation and management of primary immune thrombocytopenia

et al. 2019

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“…medicated eltrombopag from 36th gestational week to a case complicated with autosomal dominant thrombocytopenia, i.e., MYH9 -related disease, and successful platelet increase was observed [ 15 ]. Four cases of ITP, including the present case, were treated with eltrombopag (cases 3-6) [ 16 - 18 ]. Case 3 showed slight platelet increase necessitated with platelet transfusion for vaginal delivery and case 4 achieved platelet increase over 60 × 10 9 /L, however, platelet count fell to 19 × 10 9 /L at 36th week of gestation, where preeclampsia could not be ruled out from the cause of underlying pathology [ 16 ], and the patient subsequently needed platelet transfusion for delivery.…”

Section: Discussionmentioning

confidence: 99%

Use of Eltrombopag for the First Trimester Pregnancy Complicated with Refractory Idiopathic Thrombocytopenic Purpura: A Case Report and Literature Review

Shibata¹,

Misugi²,

Nakane³

et al. 2022

Cureus

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Severe idiopathic thrombocytopenic purpura (ITP) is thought to occur in approximately one in 10,000 pregnancies and refractoriness for conventional treatment is life-threatening. We herein describe a pregnant case of refractory ITP successfully treated with eltrombopag, orally medicated thrombopoietin receptor agonist (TPO-RA). The patient was diagnosed with ITP at the age of 22 and corticosteroid, immune globulin treatments, or splenectomy was invalid. Eltrombopag was administered at 25 mg/day and the platelet count was maintained at 50-80 × 10 9 /L. At the age of 32, she discontinued the medication out of fear of the possible adverse events of TPO-RA. She became pregnant and visited our hospital at the gestational age of 9th week with the result of a platelet count at 18 × 10 9 /L. Two weeks later, her platelet counts further decreased to 9 × 10 9 /L, and eltrombopag administration was resumed with 12.5 mg/day after informed written consent. The platelet counts subsequently increased and were maintained between 30 and 90 × 10 9 /L. At 34th gestational week, the dose of eltrombopag was increased to 25 mg/day in preparation for delivery and the count increased to 123 × 10 9 /L by the 38th gestational week. A healthy female infant weighing 2370 g was vaginally delivered by induced labor. Maternal blood loss was 0.4 L at delivery, and the newborn's platelet count was 173 × 10 9 /L on the second day after birth and 174 × 10 9 /L on the fifth day. The infant is neurologically and developmentally intact at 6 months of age. Regarding TPO-RA treatment for refractory ITP during pregnancy, only six pregnant cases including the present one treated with eltrombopag have been reported so far. This case is rare with reference to the use of eltrombopag for the first trimester and we increased the dose of eltrombopag at the gestational age of 34 in preparation for delivery and vaginal delivery was successful without platelet transfusion. Despite the very limited information on eltrombopag, its use might be a possible optional treatment for refractory ITP during pregnancy.

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“…The decrease in fetal weight at birth was seen only at an extremely high doses of 100 µg/kg, and doses of 1–10 µg/kg used in cases of ITP are considered to have little effect on fetal weight at birth. On the other hand, Suzuki et al reported an infant born with a low birth weight in a case of human pregnancy treated with eltrombopag [ 15 ]. However, we did not investigate the effect of eltrombopag in this study due to its limited specificity and activity on humans and chimpanzees [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Thrombopoietin Receptor Agonist on Pregnant Mice

et al. 2022

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Thrombopoietin receptor agonists (TPO-RAs) are an effective treatment for refractory immune thrombocytopenia (ITP). However, the use of TPO-RAs is limited for ITP in pregnant women due to concerns about fetal toxicity. In this study, we examined the effects of romiplostim, one of the TPO-RAs, on pregnant mice. The mice were injected subcutaneously with romiplostim (1, 5, 10, 30, and 100 μg/kg) on gestational days (GD) 1, 8, and 15. We evaluated maternal and fetal platelet and megakaryocyte counts (MK), fetal weight at birth, placental morphology, and miscarriage rates. Romiplostim increased platelet and MK counts in pregnant mice at all doses and in fetuses at doses above 10 µg/kg. Fetal weight at birth was slightly reduced at a dose of 100 μg/kg, but there were no significant differences in placental weight, spiral artery wall thickness, placental growth factor signal changes, or the rate of resorption at that dosage. The dose of romiplostim used clinically for ITP patients (1–10 μg/kg) did not show any adverse effects on pregnant mice. Although the results of the present study are encouraging, until there are more conclusive data, the use of romiplostim should be evaluated individually in severe, life-threatening cases, and all relevant ethical aspects should be considered.

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A low birth weight infant with no malformations delivered by a primary immune thrombocytopenia patient treated with eltrombopag

Cited by 21 publications

References 12 publications

Updated international consensus report on the investigation and management of primary immune thrombocytopenia

Updated international consensus report on the investigation and management of primary immune thrombocytopenia

Use of Eltrombopag for the First Trimester Pregnancy Complicated with Refractory Idiopathic Thrombocytopenic Purpura: A Case Report and Literature Review

Effect of Thrombopoietin Receptor Agonist on Pregnant Mice

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