Thrombopoietin receptor agonist switch in adult primary immune thrombocytopenia patients: A retrospective collaborative survey involving 4 Spanish centres

Abstract

TPO-RA switching is a feasible strategy in different scenarios with high probability of success.

Updated international consensus report on the investigation and management of primary immune thrombocytopenia

“…Some patients failing to respond to 1 TPO-RA may respond if switched to another TPO-RA (evidence levels IIb, III). 138,148,210,211 If not already done, splenectomy can also be reconsidered, as can searching for an accessory spleen. 212 In patients failing 1 medical therapy, changing to another medical treatment may be successful.…”

“…New data have shown that switching from 1 TPO-RA to another, as well as sequential therapy, has a positive effect on response and on tolerability (evidence levels IIb, III). 138,148,210 Switching was shown to be effective in 50% to 80% of patients, resulting in eradication of platelet fluctuation in 54% of patients and resolution of AEs in all (evidence level IIb). 138 Another study showed that switching from romiplostim to eltrombopag led to 100% response rates, but switching from eltrombopag to romiplostim led to 66% response rates, when patients switched as a result of inefficacy of the first treatment.…”

“…When switching was due to side effects or for preference, 100% of patients responded (evidence level III). 210 One study on sequential treatment revealed that sequential romiplostim and eltrombopag led to responses of 80%, and median time to relapse was 5.5 months. 211 The panel rejected using both TPO-RAs simultaneously because of excessive costs.…”

Switching thrombopoietin receptor agonist treatments in patients with primary immune thrombocytopenia

“…We identified 18 journal publications that reported retrospective findings in 401 patients with ITP who switched their TPO-RA therapy (Table 1). 21–38 In a pooled analysis of these studies, lack of efficacy was identified as the primary reason for switching in 58% of patients (172/295). Non-efficacy-related reasons for switching included adverse events (AEs), patient preference, and platelet count fluctuations.…”

“…Importantly, a high response rate (65% [72/111]) and improved platelet counts were observed even if switching was due to lack of efficacy with the first TPO-RA. 21–38…”