Romiplostim and Eltrombopag in Immune Thrombocytopenia as a Second-Line Treatment

Abstract

Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by platelet count less than 100×10 9 /L and an increased risk of bleeding. The risk of bleeding increases in proportion with the degree of thrombocytopenia. Although several medications are used for primary thrombocytopenia treatment, refractoriness remains a concern. Romiplostim and eltrombopag, two relatively new drugs, have been shown to be successful in ITP treatment after standard treatment failure. The current guidelines recommend their use as a second-line treatment. In this article, we have tried to compare which of these two medications is the best option considering clinical effectiveness, cost-effectiveness, adverse effects, and the possibility of switching between them in case of ineffectiveness. The studies used in this article were found in the PubMed database. All the studies are limited to adults. Based on these studies, both medications seem to be a largely effective, safe option. Romiplostim appears to have slightly fewer adverse effects and higher costs. Switching between thrombopoietin receptor agonists (TRAs) is a successful way to overcome adverse effects and inadequacy according to the currently available literature. We believe that more detailed studies are needed to determine which of these drugs should be considered the first choice, to report long term efficacy and adverse effects, and to determine if treatment guidelines can change regarding the use of TRAs as first-line treatment.

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

“…Romiplostim or eltrombopag have been investigated in several randomized controlled trials involving adult and pediatric ITP patients [7][8][9], and meta-analysis reports show that TPO receptor agonists with ITP patients were an effective secondline treatment option for primary ITP patients, in whom at least one previous therapy has failed [10]. Among patients treated with romiplostim, an average of 75% showed a significant response in platelet counts, whereas 69% of patients responded with eltrombopag [11]. An initial response to TPO-RA commonly appears within 1 to 2 weeks.…”

“…An initial response to TPO-RA commonly appears within 1 to 2 weeks. If one TPO-RA agent is ineffective, switching to the other leads to a platelet response in up to 50% of patients [ 11 , 12 ].…”

Eltrombopag and its beneficial role in management of ulcerative Colitis associated with ITP as an upfront therapy case report

“…Eltrombopag is well tolerated and has a good safety profile in adults. 12 Upon literature review, there are no studies or case reports that document the association between Eltrombopag and regression of IBD. Despite there is no clear pathogenesis, but the immunomodulatory effect of Eltrombopag could decrease the inflammatory response of IBD.…”

“…It can effectively increase platelet counts and reduce bleeding events in patients with chronic ITP, with an overall response rate of 60% to 80%. Eltrombopag is well tolerated and has a good safety profile in adults 12 …”

Immune thrombocytopenia

“…Response rates and the onset of action with romiplostim are similar to eltrombopag (Table 2). The sustained remission after stopping romiplostim is observed in 10-30% of patients (Cooper et al, 2019;Shirasugi et al, 2011;Bidika et al, 2020;Puravilai et al, 2020). A recent study from the United States has shown an overall response rate of more than 90% with romiplostim, which inversely correlated with the duration of ITP (Kuter et al, 2013).…”