Romiplostim as Early Treatment of Immune Thrombocytopenia with Severe Immunodeficiency

Abstract

Immunosuppressive agents are the standard therapeutic approach for immune thrombocy-topenia (ITP). Their prolonged use may increase the risk of infectious complications, particularly when the patient is already at higher infectious risk. In this setting, the use of drugs with a mechanism of action alternative to immunosuppression, like thrombopoietin receptor agonists (TRAs), may find particular indication. We report the unique case of a patient with severe immunodeficiency and ITP, who experienced a serious infectious complication while on steroids treatment, and who was successfully treated with Romiplostim second-line. The present experience supports the effectiveness and safety of TRAs as early treatment of ITP patients with drug-induced immunodeficiency or with active infections.

Platelet count control in immune thrombocytopenic purpura patient: Optimum romiplostim dose profile

“…Romiplostim, a fusion protein analog of TPO, contains two copies of the human immunoglobulin (IgG 1 ) Fc domain, each covalently linked at its C-terminus to a peptide chain containing two c-Mpl-binding peptides [11]. It has been approved in many countries as a treatment for adult patients with chronic ITP [12] and has been shown to increase platelet count (to PLT ≥ 50) in the majority of ITP patients [13][14][15].…”

Platelet count control in immune thrombocytopenic purpura patient: optimum romiplostim dose profile

“…Romiplostim has been shown to increase platelet count (to PLT ≥ 50) in the majority of ITP patients (Palandri et al 2012). However, peak platelet count in response to single romiplostim treatment is highly variable from patient to patient (Bussel et al 2006).…”