Switching From Romiplostim to Eltrombopag or Vice Versa for Immune Thrombocytopenia: Efficacy and Safety in 46 Patients

Abstract 4651

Romiplostim and eltrombopag, the first thrombopoietic receptor-agonists (TPO-RAs) with demonstrated efficacy against immune thrombocytopenia (ITP) in prospective controlled studies, were recently authorized in Europe for adults with chronic ITP. Their efficacies and safety profiles were evaluated in 46 ITP patients who sequentially received both drugs. Thirty-five patients first received romiplostim (romiplostim group), whereas eltrombopag (eltrombopag group) was the first TPO-RA for 11 patients. All but 2 patients had previously received corticosteroids and IVIg, and 70% had been given rituximab without responding. The splenectomy rate was 50% (23/46). Patients were switching from one to the other for the following reasons: lack of efficacy for half of them, platelet-count fluctuations for 11, side effects for 4 and 8 patients' preferences. For 50% to 80% of the patients, switching from 1 TPO-RA to the other effectively impacted the platelet count, with the disappearance of its fluctuations in 54%, and side effects resolved in 100%. In 80% of the patients, the 2 TPO-RAs achieved similar response patterns. Our results confirmed that switching from 1 TPO-RA to the other could be beneficial in clinical practice for patients with severe chronic ITP who failed to respond or experienced adverse events(s) to the first.