Avatrombopag plus fostamatinib combination as treatment in patients with multirefractory immune thrombocytopenia

Mingot‐Castellano, Maria Eva; Bastida, Jose Maria; Ghanima, Waleed; Ruiz Sainz, Elena; Nuñez Vazquez, Ramiro; Pedrote Amador, Begoña; Abdel‐Kader Martín, Laila; Piquer‐Monsonis, Dolores; Canaro, Mariana

doi:10.1111/bjh.19602

Br J Haematol

2024

DOI: 10.1111/bjh.19602

|View full text |Cite

Avatrombopag plus fostamatinib combination as treatment in patients with multirefractory immune thrombocytopenia

Maria Eva Mingot‐Castellano,

Jose Maria Bastida,

Waleed Ghanima

et al.

Abstract: SummaryImmune thrombocytopenia (ITP) refractory to multiple therapies may require a combination of drugs targeting different mechanisms and targets. In this retrospective, multicentre, international study, we report the safety and effectiveness of avatrombopag and fostamatininb in combination administered to 18 patients with multirefractory ITP. Overall, the combination response was achieved in 15 patients (83.3%), with a median time from combination start to best response of 15 days (IQR: 8–35 days). After a … Show more

Help me understand this report

Search citation statements

Order By: Relevance

Paper Sections

Select...

Citation Types

Supporting

Mentioning

Contrasting

Year Published

2024

Publication Types

Select...

Article2

Relationship

Self Cite0

Independent2

Authors

Journals

Cited by 2 publications

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Avatrombopag in immune thrombocytopenia: A real‐world study of the Spanish ITP Group (GEPTI)

Pascual‐Izquierdo,

Sánchez‐González,

Canaro‐Hirnyk

et al. 2024

American J Hematol

View full text Add to dashboard Cite

Avatrombopag is the newest thrombopoietin receptor agonist (TPO‐RA) approved to treat immune thrombocytopenia (ITP). Real‐world evidence regarding effectiveness/safety is limited. The Spanish ITP Group (GEPTI) performed a retrospective study with patients starting avatrombopag for the first time. A total of 268 ITP patients were recruited. The median (interquartile range [IQR]) follow‐up time was 47.5 (30.4–58.9) weeks. Among the 193 patients with baseline platelet counts <50 × 109/L, 174 (90.1%) of them achieved response (PC ≥50 × 109/L), and 113 (87.6%) of the 129 who persisted on avatrombopag at last visit had platelet levels above such threshold. Results were similar when only those patients switching to avatrombopag due to previous treatment failure were considered (n = 104). Patients reached response in 13 (7–21) days. Among patients with baseline levels ≥50 × 109/L, 73/75 (97.3%) reported response, which was maintained by 53 (94.6%) of the 56 who continued on avatrombopag at the end of the study. Loss‐of‐response was always <10%. ITP duration did not influence response. Approximately 79% (34/43) of heavily pretreated (≥4 lines) patients with baseline platelet counts <50 × 109/L switching after previous failure achieved PC ≥50 × 109/L. Previous use of eltrombopag and/or romiplostim did not influence response, regardless of whether previous TPO‐RA(s) succeeded or failed. Avatrombopag allowed dose‐reduction/suspension of corticosteroids in 40/50 (80.0%) patients with baseline platelet counts <50 × 109/L. Overall, 40/268 (14.9%) thrombocytosis and 12/268 (4.5%) thromboembolic events were reported. Our real‐world cohort supports the use of avatrombopag to manage ITP, regardless of disease severity and treatment history.

show abstract

Avatrombopag in immune thrombocytopenia: A real‐world study of the Spanish ITP Group (GEPTI)

Pascual‐Izquierdo,

Sánchez‐González,

Canaro‐Hirnyk

et al. 2024

American J Hematol

View full text Add to dashboard Cite

show abstract

Insights on treatment of adult ITP: algorithm for management and role of multimodal therapy

Ghanima,

Cuker,

Michel

2024

Hematology

View full text Add to dashboard Cite

The management of immune thrombocytopenia (ITP) is continuously evolving with the development and introduction of newer therapies and a better understanding of the disease. Corticosteroids still represent the cornerstone of first-line treatment. Patients who fail to achieve remission with a short course of corticosteroids require subsequent therapy. Most guidelines recommend starting with either a thrombopoietin receptor agonist (TPO-RA), rituximab, or fostamatinib since these agents have been investigated in randomized trials and have well-characterized efficacy and safety profiles. Patients' involvement to reach a shared decision regarding choice of therapy is essential as these treatments have different modes of administration and mechanisms of action. Less than 10% will fail to respond to and/or be intolerant of multiple second-line therapeutic options and thus be considered to have refractory ITP and require a third-line therapeutic option. Such patients may require drugs with different targets or a combination of drugs with different mechanisms of action. Combining a TPO-RA and an immunomodulatory agent may be an appropriate approach at this stage. Many studies have been conducted during the last 2 decades investigating the efficacy and safety of combinations strategies for first and later lines of therapies. Yet none of these are recommended by current guidelines or have gained wide acceptance and consensus.

show abstract

scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.

Contact Info

customersupport@researchsolutions.com

10624 S. Eastern Ave., Ste. A-614

Henderson, NV 89052, USA

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

Blog Terms and Conditions API Terms Privacy Policy Contact Cookie Preferences Do Not Sell or Share My Personal Information

Made with 💙 for researchers

Part of the Research Solutions Family.

Avatrombopag plus fostamatinib combination as treatment in patients with multirefractory immune thrombocytopenia

Cited by 2 publications

References 10 publications

Avatrombopag in immune thrombocytopenia: A real‐world study of the Spanish ITP Group (GEPTI)

Avatrombopag in immune thrombocytopenia: A real‐world study of the Spanish ITP Group (GEPTI)

Insights on treatment of adult ITP: algorithm for management and role of multimodal therapy

Contact Info

Product

Resources

About