Adults with immune thrombocytopenia who switched to avatrombopag following prior treatment with eltrombopag or romiplostim: A multicentre US study

Al‐Samkari, Hanny; Jiang, Debbie; Gernsheimer, Terry; Liebman, Howard A.; Lee, Susie; Wojdyla, Matthew; Vredenburg, Michael; Cuker, Adam

doi:10.1111/bjh.18081

Cited by 46 publications

(44 citation statements)

References 20 publications

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“…Avatrombopag is a second-generation TPO-RA approved for second-line treatment of primary chronic ITP. A multicenter study performed in the United States confirmed that: patients with ITP who previously used other TPO-RAs (eltrombopag or romiplostim) and responded poorly exhibited a high response rate to avatrombopag ( 71 ). Thus, TPO-RA may be another option for treating PGF.…”

Section: The Soilmentioning

confidence: 92%

Recent Advancements in Poor Graft Function Following Hematopoietic Stem Cell Transplantation

Man

Yao

et al. 2022

Front. Immunol.

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Poor graft function (PGF) is a life-threatening complication that occurs after transplantation and has a poor prognosis. With the rapid development of haploidentical hematopoietic stem cell transplantation, the pathogenesis of PGF has become an important issue. Studies of the pathogenesis of PGF have resulted in some success in CD34+-selected stem cell boosting. Mesenchymal stem cells, N-acetyl-l-cysteine, and eltrombopag have also been investigated as therapeutic strategies for PGF. However, predicting and preventing PGF remains challenging. Here, we propose that the seed, soil, and insect theories of aplastic anemia also apply to PGF; CD34+ cells are compared to seeds; the bone marrow microenvironment to soil; and virus infection, iron overload, and donor-specific anti-human leukocyte antigen antibodies to insects. From this perspective, we summarize the available information on the common risk factors of PGF, focusing on its potential mechanism. In addition, the safety and efficacy of new strategies for treating PGF are discussed to provide a foundation for preventing and treating this complex clinical problem.

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Section: The Soilmentioning

confidence: 92%

Recent Advancements in Poor Graft Function Following Hematopoietic Stem Cell Transplantation

Man

Yao

et al. 2022

Front. Immunol.

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“… 77 In case of failure to eltrombopag and romiplostim, response can be obtained with a switch to avatrombopag. 78 Because they increase platelet production, TPO-RAs have long been considered to very rarely lead to sustained remission off-treatment in ITP, but we now have evidence for sustained remission after their discontinuation in 10% to 30% of patients. 79 , 80 Therefore, after a response is obtained, the treatment should be tapered in order to use the lowest dose to maintain platelet counts.…”

Section: Itp Treatments: What Tolerance and What Efficacy In Older Pa...mentioning

confidence: 99%

Older Adults and Immune Thrombocytopenia: Considerations for the Clinician

Crickx¹,

Mahévas²,

Michel³

et al. 2023

CIA

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Many epidemiological studies have shown that the incidence of immune thrombocytopenia (ITP) increases after age 60 years and peaks in patients over age 80 years. Therefore, ITP is a concern for physicians taking care of older patients, especially regarding its diagnosis and management. The diagnostic work-up should exclude other causes of thrombocytopenia and secondary ITP, including myelodysplastic syndrome and drug-induced ITP. The treatment decision is influenced by an increased risk of bleeding, infectious diseases and thrombosis in this population and should take into account comorbidities and concomitant medications such as anticoagulant drugs. First-line treatment is based on short corticosteroids courses and intravenous immunoglobulin, which should be reserved for patients with more severe bleeding complications, with their higher risk of toxic effects as compared with younger patients. Second-line treatment should be tailored to the patient’s history, comorbidities and preferences. Preferred second-line treatments are thrombopoietin receptor agonists for most groups and guidelines given their good efficacy/tolerance ratio, but the thrombotic risk is increased in older people. Other second-line options that can be good alternatives depending on the clinical context include rituximab, dapsone, fostamatinib or immunosuppressive drugs. Splenectomy is less often performed but remains an option for fit patients with chronic refractory disease. Emerging treatments such as Syk or Bruton tyrosine kinase inhibitors and FcRn antagonists are becoming available for ITP and may modify the treatment algorithm in the near future. The aim of this review is to describe the particularities of the diagnosis and treatment of ITP in older people, including the response and tolerance to the currently available drugs. We also discuss some situations related to co-morbidities that can frequently lead to adapt the management strategy in older patients.

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“…The selection of these thrombopoietic agents mainly depends on drug availability, patient-preferred administration form, and anticipated adherence. Furthermore, failing one thrombopoietic agent does not preclude the use of another, as there is accumulating evidence supporting TPO-RA agent switching due to treatment failure, which could induce a platelet response in up to 50–75% of patients [ 132 – 134 ].…”

Section: Subsequent Treatmentmentioning

confidence: 99%

How we treat primary immune thrombocytopenia in adults

Liu

Hou

2023

J Hematol Oncol

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Primary immune thrombocytopenia (ITP) is an immune-mediated bleeding disorder characterized by decreased platelet counts and an increased risk of bleeding. Multiple humoral and cellular immune abnormalities result in accelerated platelet destruction and suppressed platelet production in ITP. The diagnosis remains a clinical exclusion of other causes of thrombocytopenia. Treatment is not required except for patients with active bleeding, severe thrombocytopenia, or cases in need of invasive procedures. Corticosteroids, intravenous immunoglobulin, and anti-RhD immunoglobulin are the classical initial treatments for newly diagnosed ITP in adults, but these agents generally cannot induce a long-term response in most patients. Subsequent treatments for patients who fail the initial therapy include thrombopoietic agents, rituximab, fostamatinib, splenectomy, and several older immunosuppressive agents. Other potential therapeutic agents, such as inhibitors of Bruton’s tyrosine kinase and neonatal Fc receptor, are currently under clinical evaluation. An optimized treatment strategy should aim at elevating the platelet counts to a safety level with minimal toxicity and improving patient health-related quality of life, and always needs to be tailored to the patients and disease phases. In this review, we address the concepts of adult ITP diagnosis and management and provide a comprehensive overview of current therapeutic strategies under general and specific situations.

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Adults with immune thrombocytopenia who switched to avatrombopag following prior treatment with eltrombopag or romiplostim: A multicentre US study

Cited by 46 publications

References 20 publications

Recent Advancements in Poor Graft Function Following Hematopoietic Stem Cell Transplantation

Recent Advancements in Poor Graft Function Following Hematopoietic Stem Cell Transplantation

Older Adults and Immune Thrombocytopenia: Considerations for the Clinician

How we treat primary immune thrombocytopenia in adults

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