The Outcomes and Adverse Drug Patterns of Immunomodulators and Thrombopoietin Receptor Agonists in Primary Immune Thrombocytopenia Egyptian Patients with Hemorrhage Comorbidity

Abstract

Immune thrombocytopenia (ITP) treatment has evolved recently. However, none of the treatments have only benefits without drawbacks. This study aimed to compare the clinical outcomes and adverse drug patterns of Eltrombopag, Romiplostim, Prednisolone + Azathioprine, High Dose-dexamethasone (HD-DXM) (control group), and Rituximab in primary ITP Egyptian patients. All patients were initiated with corticosteroids, HD-DXM, as a first-line treatment for the first month immediately following diagnosis. Four hundred sixty-seven ITP patients were randomly assigned to five groups. The outcome measures were judged at baseline, at the end of treatment (6 months), and after an additional 6-month free treatment period. The follow-up period for which relapse is noted was 6 months after the end of treatment. Eltrombopag and Romiplostim resulted in a significantly higher incidence of sustained response than Rituximab, HD-DXM, and Prednisolone + Azathioprine (55.2% and 50.6% vs. 29.2%, 29.1%, and 18%, respectively; p-value < 0.001). More patients on immunomodulators (Prednisolone+ Azathioprine, HD-DXM, and Rituximab) relapsed than those on Romiplostim and Eltrombopag (81.9%, 70.8%, and 70.7% vs. 49.3%, and 44.7%, respectively; p-value < 0.01). We also describe 23 reports of pulmonary hypertension with Prednisolone+ Azathioprine and 13 reports with HD-DXM. The thrombotic events occurred in 16.6% and 13% of patients who received Eltrombopag and Romiplostim treatment, respectively. Most patients had at least one or two risk factors (92.8% of cases). Corticosteroids are effective first-line therapy in primary ITP patients. However, relapse is frequent. Eltrombopag and Romiplostim are safer and more effective than Prednisolone, HD-DXM, and Rituximab. They might be reasonable beneficial options after a one-month HD-DXM regimen.

Therapeutic Outcomes of High Dose-Dexamethasone versus Prednisolone + Azathioprine, Rituximab, Eltrombopag, and Romiplostim Strategies in Persistent, Chronic, Refractory, and Relapsed Immune Thrombocytopenia Patients

“…TPO-RAs had an encouraging impact on this study. The efficacy of TPO-RA in the first-line setting is not supported by sufficient evidence, according to recent studies [ 3 , 38 , 39 , 40 ]. These studies demonstrated that combining TPO-RAs and Dexamethasone is a potential first-line treatment for ITP.…”

“…Primary immune thrombocytopenia (ITP) is an autoimmune hemorrhage disorder characterized by impairment of platelet production and immunological abnormalities resulting in platelet destruction [ 1 ]. Severe internal bleeding can occur as a consequence [ 2 , 3 ]. ITP affects approximately 1 in every 20,000 individuals, with females being more affected than males [ 4 , 5 , 6 ].…”

“…However, despite an initial response in 60–70% of patients, most responders experience relapse, with only 15–40% achieving a durable sustained response [ 18 ]. Second-line treatment options such as Rituximab (RTX), Azathioprine (AZA), and TPO-RAs like Eltrombopag (ELTRO) or Romiplostim (ROMP) are recommended by the American Society of Hematology guidelines for treating corticosteroid-resistant or intolerant ITP [ 3 , 17 , 19 ]. Nowadays, splenectomy is delayed and only considered following TPO-RAs and/or rituximab failure.…”

An Open Access Strategy for the Drug Repurposing Community

“…In [30], they propose Prednisone as a treatment for allergic rhinitis. In the case of hypertension, there are studies that relate the impact of Prednisone on this disease, but mainly in a negative way [50]. In [13], they already found that some of the predictions made were contraindications to the disease, as the included relations are too general.…”

Clinical Care Team’s Guide for Awareness on Risk Assessment of Eltrombopag Complicating Acute Kidney Injury in Relapsed Immune Thrombocytopenic Patients: A Case Report

“…Eltrombopag is a non-peptide thrombopoietin receptor agonist that promotes megakaryocyte growth [ 18 ]. Recent ITP studies reported that adverse events had happened during Eltrombopag use, such as thrombosis, liver cirrhosis, elevated liver enzymes, osteoporosis, pulmonary hypertension, plantar fasciitis, numbness, tingling, headache, dizziness, and fatigue [ 19 , 20 , 21 ].…”