A multi-centric study on the efficacy of eltrombopag in management of refractory chronic immune thrombocytopenia

• DOI: 10.4274/tjh.galenos.2019.2018.0307
• Publication Date: 2019-07-22T06:14:51Z
• Authors: Demet Cekdemir; Serkan Guvenc; Fusun Ozdemirkiran; Ali Eser; Tayfur Toptas; Vildan Ozkocaman; Handan Haydaroglu...; Esra Ermis Turak; Ramazan Esen; Melda Comert; Sevil Sadri; Muzeyyen Aslaner; Bahar Uncu Ulu; Abdullah Karakus; Derya Selim Bapur; Inci Alacacioglu; Demet Aydin; Atakan Tekinalp; Sinem Namdaroglu; Funda Ceran; Pinar Tarkun; Demet Kiper; Mustafa Cetiner; Mustafa Yenerel; Ahmet Muzaffer Demir; Guven Yilmaz; Hatice Terzi; Erden Atilla; Umit Yavuz Malkan; Kadir Acar; Erman Ozturk; Anil Tombak; Cenk Sunu; Ozan Salim; Nevin Alayvaz; Ozkan Sayan; Ulku Ozan; Mesut Ayer; Zafer Gokgoz; Neslihan Andic; Ebru Kizilkilic; Figen Noyan; Mehmet Ozen; Funda Pepedil Tan...; Guchan Alanoglu; Hasan Atilla Ozkan; Vahap Aslan; Guven Cetin; Alev Akyol Erikci; Burak Deveci; Fadime Ersoy Dursun; Hasan Dermenci; Pelin Aytan; Mehmet Gunduz; Volkan Karakus; Can Ozlu; Sinan Demircioglu; Olga Meltem Akay ...; Duzgun Ozatli; Levent Undar; Eyup Naci Tiftik; Ayhan Gulsan Turk...; Ibrahim Haznedaroglu; Muhit Ozcan; Mehmet Sencan; Murat Tombuloglu; Gulsum Ozet; Oktay Bilgir; Burhan Turgut; Mehmet Ali Ozcan; Kadriye Bahriye P...; Mehmet Sonmez; Orhan Ayyildiz; Mehmet Sinan Dal; Sehmus Ertop; Mehmet Turgut; Teoman Soysal; Emin Kaya; Ali Unal; Mustafa Pehlivan; Isık Atagunduz; Tulin Tuglular Fi...; Guray Saydam; Reyhan Diz Kucukkaya
• Keywords: Adult; Male; Adolescent; Eltrombopag; Immune thrombocytopenic; Thrombocytopenia; thrombocytopenia; Long-Term; Benzoates; 0-Belirlenecek; Young Adult; Medicine; Hematology; Adults; Humans; Diseases of the blood and blood-forming organs; Child; Purpura; Aged; Aged, 80 and over; [Anahtar Kelime Yok]; Purpura, Thrombocytopenic, Idiopathic; A Real-Life Experience-, TURKISH JOURNAL OF HEMATOLOGY, cilt.36, ss.230-237, 2019 [Cekdemir D., Guvenc S., Ozdemirkiran F., Eser A., Topts T., ÖZKOCAMAN V., ŞAHİN H. H. , ERMİŞ TURAK E., Esen R., Comert M., et al., -A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia]; [No Keywords]; Immune thrombocytopenic; Hematology; Middle Aged; Thrombocytopenia; 3. Good health; Hydrazines; immune thrombocytopenic; Child, Preschool; Eltrombopag; Chronic Disease; Itp; Pyrazoles; Female; Safety; RC633-647.5; eltrombopag; Research Article

The aim of the present study was to evaluate the efficacy and safety of eltrombopag, an oral thrombopoietin receptor agonist, in patients with chronic immune thrombocytopenia (ITP).A total of 285 chronic ITP patients (187 women, 65.6%; 98 men, 34.4%) followed in 55 centers were enrolled in this retrospective cohort. Response to treatment was assessed according to platelet count (/mm3) and defined as complete (platelet count of >100,000/mm3), partial (30,000-100,000/mm3 or doubling of platelet count after treatment), or unresponsive (<30,000/mm3). Clinical findings, descriptive features, response to treatment, and side effects were recorded. Correlations between descriptive, clinical, and hematological parameters were analyzed.The median age at diagnosis was 43.9±20.6 (range: 3-95) years and the duration of follow-up was 18.0±6.4 (range: 6-28.2) months. Overall response rate was 86.7% (n=247). Complete and partial responses were observed in 182 (63.8%) and 65 (22.8%) patients, respectively. Thirty-eight patients (13.4%) did not respond to eltrombopag treatment. For patients above 60 years old (n=68), overall response rate was 89.7% (n=61), and for those above 80 years old (n=12), overall response rate was 83% (n=10). Considering thrombocyte count before treatment, eltrombopag significantly increased platelet count at the 1st, 2nd, 3rd, 4th, and 8th weeks of treatment. As the time required for partial or complete response increased, response to treatment was significantly reduced. The time to reach the maximum platelet levels after treatment was quite variable (1-202 weeks). Notably, the higher the maximum platelet count after eltrombopag treatment, the more likely that side effects would occur. The most common side effects were headache (21.6%), weakness (13.7%), hepatotoxicity (11.8%), and thrombosis (5.9%).Results of the current study imply that eltrombopag is an effective therapeutic option even in elderly patients with chronic ITP. However, patients must be closely monitored for response and side effects during treatment. Since both response and side effects may be variable throughout the follow-up period, patients should be evaluated dynamically, especially in terms of thrombotic risk factors.