Background Eltrombopag is a thrombopoietin mimetic indicated in immune thrombocytopenia when corticosteroids or splenectomy are not effective or splenectomy is contraindicated. No direct comparison exists with romiplostim.
Purpose To evaluate the effectiveness and safety of eltrombopag since its inclusion in the pharmacotherapeutic guide.
Materials and methods Retrospective study of patients treated August 2011 – February 2013. Demographic data, pretreatments, splenectomy, platelet count (PC) at the beginning, at five weeks and at the end of the treatment or study, adverse effects and discontinuation, were collected.
Results 8 women and 1 man, median age 63 (24–78). Five were splenectomised, all of them pretreated with corticosteroids, 7 with azathioprine, Danatrol or dapsone and 7 with romiplostim. Before treatment with romiplostim median PC was 4,000/mm3 (3,000–25,000) and after five weeks 75% had ≥50,000. 3 patients discontinued for inefficacy, 1 for partial response with a high dose, 2 for adverse effects and one was changed to eltrombopag for oral route administration. At the start of eltrombopag administration the median PC was 6,000 (2,000–68,000), after five weeks 44% had ≥50,000. At the end of study 6 patients had discontinued treatment, two due to lack of response, one was intolerant, one refused treatment for his liver disease, one was splenectomised and another had a sustained response. 3 patients continued with eltrombopag for a median of 70 weeks (57–78) and at the end of the study median platelet count was 45,000 (34,000–60,000). Thromboembolic complications, cataracts, bone marrow reticulin or liver damage were not reported. Two patients reported irritability and fatigue and another headache.
Conclusions Both romiplostim and eltrombopag increased platelet count ≥50,000/mm3 more than placebo. Advantages of eltrombopag are oral versus subcutaneous administration and easier dosing. In an indirect comparison romiplostim achieved a better platelet response after 4 weeks of treatment, like in our study, but we observed more discontinuation with romiplostim due to lack of response or partial response (57% vs. 22%).
No conflict of interest.
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