Effectiveness of Thrombopoietin-receptor Agonists in the Treatment of Refractory Immune Thrombocytopenia Associated to Systemic Lupus Erythematosus

Magnano, Laura; Enríquez, Hector; Esteve, Jordi; Cervera, Ricard; Espinosa, Gerard

doi:10.3899/jrheum.140080

Cited by 20 publications

(18 citation statements)

References 12 publications

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“…There are very few reported cases of ITP secondary to autoimmune disorders successfully treated with THPO-RAs. (Gonzalez-Nieto et al, 2011;Alkaabi et al, 2012;Ruiz-Arguelles et al, 2013;Magnano et al, 2014;Scheinberg et al, 2014;Chang & Shih, 2015;Maroun et al, 2015) Here we report an excellent response in ITP secondary to autoimmune disorders. Similarly, the response rate in ITP secondary to infectious disorders was excellent.…”

Section: Discussionsupporting

confidence: 58%

“…Also, eltrombopag is currently approved by the US Food and Drug Administration and the European Medicines Agency for the treatment of thrombocytopenia secondary to aplastic anaemia (Olnes et al, 2012) and thrombocytopenia secondary to hepatitis C infection (McHutchison et al, 2007;Afdhal et al, 2012). Eltrombopag has also been successfully used in a very small number of patients with immune thrombocytopenia secondary to chronic lymphatic leukaemia (Koehrer et al, 2010;Sinisalo et al, 2011;Gudbrandsdottir et al, 2012;Jolliffe & Romeril, 2014;Chang & Shih, 2015), systemic lupus erythematosus (SLE: Chang & Shih, 2015;Gonzalez-Nieto et al, 2011;Alkaabi et al, 2012;Scheinberg et al, 2014;Magnano et al, 2014;Maroun et al, 2015), Evans syndrome (Gonzalez-Nieto et al, 2011;Alkaabi et al, 2012;Ruiz-Arguelles et al, 2013;Magnano et al, 2014;Scheinberg et al, 2014;Chang & Shih, 2015;Maroun et al, 2015), human immunodeficiency virus (Quach et al, 2012;Aslam et al, 2014;Chang & Shih, 2015;Kowalczyk et al, 2015) and coeliac disease (Chang & Shih, 2015) who had a loss of response to standard treatment for ITP. The communication of such cases is essential to support the potential utility of eltrombopag as salvage therapy in the treatment of secondary immune thrombocytopenia.…”

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confidence: 99%

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Use of eltrombopag for secondary immune thrombocytopenia in clinical practice

et al. 2017

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Eltrombopag is a second-line treatment in primary immune thrombocytopenia (ITP). However, its role in secondary ITP is unknown. We evaluated the efficacy and safety of eltrombopag in secondary ITP in daily clinical practice. Eighty-seven secondary ITP patients (46 with ITP secondary to autoimmune syndromes, 23 with ITP secondary to a neoplastic disease subtype: lymphoproliferative disorders [LPDs] and 18 with ITP secondary to viral infections) who had been treated with eltrombopag were retrospectively evaluated. Forty-four patients (38%) had a platelet response, including 40 (35%) with complete responses. Median time to platelet response was 15 days (95% confidence interval, 7-28 days), and was longer in the LPD-ITP group. Platelet response rate was significantly lower in the LPD-ITP than in other groups. However, having achieved response, there were no significant differences between the durable response of the groups. Forty-three patients (49·4%) experienced adverse events (mainly grade 1-2), the commonest being hepatobiliary laboratory abnormalities. There were 10 deaths in this case series, all of which were related to pre-existing medical conditions. In routine clinical practice, eltrombopag is effective and well-tolerated in unselected patients with ITP secondary to both immune and infectious disorders. However, the response rate in LPD-ITP is low.

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Section: Discussionsupporting

confidence: 58%

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confidence: 99%

Use of eltrombopag for secondary immune thrombocytopenia in clinical practice

et al. 2017

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“…However, few publications have been issued to date regarding usefulness of TPO analogs in secondary ITP of the elderly . Thus, limited communications point out their success when treating ITP secondary to autoimmune diseases or lymphoproliferative disorders (LPDs) in patients aged ≥65 years. Our efficacy results in secondary ITP show high response rates in immune and infectious ITP with poor results in LPD‐ITP.…”

Section: Discussionmentioning

confidence: 99%

Use of eltrombopag for patients 65 years old or older with immune thrombocytopenia

González-López

Sánchez‐González

Jarque

et al. 2020

European J of Haematology

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Background Eltrombopag is useful for immune thrombocytopenia (ITP). However, results of clinical trials may not accurately mirror clinical practice reality. Here we evaluated eltrombopag for primary and secondary ITP in our ≥65‐year‐old population. Methods A total of 106 primary ITP patients (16 with newly diagnosed ITP, 16 with persistent ITP, and 74 with chronic ITP) and 39 secondary ITP patients (20 with ITP secondary to immune disorders, 7 with ITP secondary to infectious diseases, and 12 with ITP secondary to lymphoproliferative disorders [LPD]) were retrospectively evaluated. Results Median age of our cohort was 76 (interquartile range, IQR, 70‐81) years. 75.9% of patients yielded a platelet response including 66.2% complete responders. Median time to platelet response was 14 (IQR, 8‐21) days. Median time on response was 320 (IQR, 147‐526) days. Sixty‐three adverse events (AEs), mainly grade 1‐2, occurred. The most common were hepatobiliary laboratory abnormalities (HBLAs) and headaches. One transient ischemic attack in a newly diagnosed ITP and two self‐limited pulmonary embolisms in secondary ITP were the only thrombotic events observed. Conclusion Eltrombopag showed efficacy and safety in ITP patients aged ≥65 years with primary and secondary ITP. However, efficacy results in LPD‐ITP were poor. A relatively high number of deaths were observed.

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“…There have been reports of thrombocytopenia in patients with SLE who have been treated with these drugs with good results [3,4].…”

Section: Opinion Articlementioning

confidence: 99%

“…In immune thrombocytopenia, autoantibodies produced by autoreactive B cells binding to megakaryocyte membranes could interfere with megakaryocyte maturation, thus resulting in decreased platelet production [2]. It has been shown anti-thrombopoietin antibodies in patients with SLE [4].…”

Section: Opinion Articlementioning

confidence: 99%