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Thrombopoietin receptor agonists in refractory immune thrombocytopenia: differential responses to eltrombopag and romiplostim: a case report and possible explanations.
J Clin Pharm Ther. 2012 Dec; 37(6):729-32.JC

Abstract

WHAT IS KNOWN AND OBJECTIVE

Although new thrombopoietin (TPO) receptor agonist drugs, such as romiplostim and eltrombopag, are highly effective and well tolerated for patients with immune thrombocytopenia (ITP) refractory to first-line treatments such as prednisolone, the cross-resistance of these two TPO receptor agonists is still unknown.

CASE SUMMARY

An 84-year-old Japanese female patient with steroid-refractory ITP received eltrombopag with a gradually increasing dose schedule from 12.5 to 25 mg/day, 37.5 mg/day and finally 50 mg/day. As no increase in platelet count was observed even at the maximum dose of 50 mg/day, and eltrombopag-related grade 3 elevation of aspartate aminotransferase was observed, another TPO receptor agonist, romiplostim, was administered at 1 μg/kg/week subcutaneously. A rapid increase in platelet count was observed 1 week after the first injection. The dose of romiplostim was escalated to 4 μg/kg according to the platelet count and a complete response was achieved 7 weeks after the first injection without any adverse events.

WHAT IS NEW AND CONCLUSION

The successful treatment of ITP refractory to eltrombopag with romiplostim strongly suggests that the absence of cross-resistance between these two approved TPO receptor agonists and possible differences in mechanism of action. Further study of the mechanisms of action of TPO receptor agonists is called for along with further exploration of the potential of romiplostim in refractory ITP.

Authors+Show Affiliations

Department of Hematology and Oncology, Nagoya Daini Red Cross Hospital, Showa-ku, Nagoya, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Comparative Study
Journal Article

Language

eng

PubMed ID

22583038

Citation

Aoki, T, et al. "Thrombopoietin Receptor Agonists in Refractory Immune Thrombocytopenia: Differential Responses to Eltrombopag and Romiplostim: a Case Report and Possible Explanations." Journal of Clinical Pharmacy and Therapeutics, vol. 37, no. 6, 2012, pp. 729-32.
Aoki T, Harada Y, Matsubara E, et al. Thrombopoietin receptor agonists in refractory immune thrombocytopenia: differential responses to eltrombopag and romiplostim: a case report and possible explanations. J Clin Pharm Ther. 2012;37(6):729-32.
Aoki, T., Harada, Y., Matsubara, E., Suzuki, T., Oyama, T., Kasai, M., Uchida, T., & Ogura, M. (2012). Thrombopoietin receptor agonists in refractory immune thrombocytopenia: differential responses to eltrombopag and romiplostim: a case report and possible explanations. Journal of Clinical Pharmacy and Therapeutics, 37(6), 729-32. https://doi.org/10.1111/j.1365-2710.2012.01353.x
Aoki T, et al. Thrombopoietin Receptor Agonists in Refractory Immune Thrombocytopenia: Differential Responses to Eltrombopag and Romiplostim: a Case Report and Possible Explanations. J Clin Pharm Ther. 2012;37(6):729-32. PubMed PMID: 22583038.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thrombopoietin receptor agonists in refractory immune thrombocytopenia: differential responses to eltrombopag and romiplostim: a case report and possible explanations. AU - Aoki,T, AU - Harada,Y, AU - Matsubara,E, AU - Suzuki,T, AU - Oyama,T, AU - Kasai,M, AU - Uchida,T, AU - Ogura,M, Y1 - 2012/05/14/ PY - 2012/5/16/entrez PY - 2012/5/16/pubmed PY - 2013/4/20/medline SP - 729 EP - 32 JF - Journal of clinical pharmacy and therapeutics JO - J Clin Pharm Ther VL - 37 IS - 6 N2 - WHAT IS KNOWN AND OBJECTIVE: Although new thrombopoietin (TPO) receptor agonist drugs, such as romiplostim and eltrombopag, are highly effective and well tolerated for patients with immune thrombocytopenia (ITP) refractory to first-line treatments such as prednisolone, the cross-resistance of these two TPO receptor agonists is still unknown. CASE SUMMARY: An 84-year-old Japanese female patient with steroid-refractory ITP received eltrombopag with a gradually increasing dose schedule from 12.5 to 25 mg/day, 37.5 mg/day and finally 50 mg/day. As no increase in platelet count was observed even at the maximum dose of 50 mg/day, and eltrombopag-related grade 3 elevation of aspartate aminotransferase was observed, another TPO receptor agonist, romiplostim, was administered at 1 μg/kg/week subcutaneously. A rapid increase in platelet count was observed 1 week after the first injection. The dose of romiplostim was escalated to 4 μg/kg according to the platelet count and a complete response was achieved 7 weeks after the first injection without any adverse events. WHAT IS NEW AND CONCLUSION: The successful treatment of ITP refractory to eltrombopag with romiplostim strongly suggests that the absence of cross-resistance between these two approved TPO receptor agonists and possible differences in mechanism of action. Further study of the mechanisms of action of TPO receptor agonists is called for along with further exploration of the potential of romiplostim in refractory ITP. SN - 1365-2710 UR - https://www.unboundmedicine.com/medline/citation/22583038/Thrombopoietin_receptor_agonists_in_refractory_immune_thrombocytopenia:_differential_responses_to_eltrombopag_and_romiplostim:_a_case_report_and_possible_explanations_ L2 - https://doi.org/10.1111/j.1365-2710.2012.01353.x DB - PRIME DP - Unbound Medicine ER -