A Multi-Center Study on the Efficacy of Eltrombopag in Management of Refractory Chronic Immune Thrombocytopenia: A Real-Life Experience

• Published in: Turkish journal of haematology Vol. 36; no. 4; pp. 230 - 237
• Main Authors: Çekdemir, Demet, Güvenç, Serkan, Özdemirkıran, Füsun, Eser, Ali, Toptaş, Tayfur, Özkocaman, Vildan, Haydaroğlu Şahin, Handan, Ermiş Turak, Esra, Esen, Ramazan, Cömert, Melda, Sadri, Sevil, Aslaner, Müzeyyen, Uncu Ulu, Bahar, Karakuş, Abdullah, Selim Bapur, Derya, Alacacıoğlu, İnci, Aydın, Demet, Tekinalp, Atakan, Namdaroğlu, Sinem, Ceran, Funda, Tarkun, Pınar, Kiper, Demet, Çetiner, Mustafa, Yenerel, Mustafa, Demir, Ahmet Muzaffer, Yılmaz, Güven, Terzi, Hatice, Atilla, Erden, Malkan, Ümit Yavuz, Acar, Kadir, Öztürk, Erman, Tombak, Anıl, Sunu, Cenk, Salim, Ozan, Alayvaz, Nevin, Sayan, Özkan, Ozan, Ülkü, Ayer, Mesut, Gökgöz, Zafer, Andıç, Neslihan, Kızılkılıç, Ebru, Noyan, Figen, Özen, Mehmet, Pepedil Tanrıkulu, Funda, Alanoğlu, Güçhan, Özkan, Hasan Atilla, Aslan, Vahap, Çetin, Güven, Akyol Erikçi, Alev, Deveci, Burak, Ersoy Dursun, Fadime, Dermenci, Hasan, Aytan, Pelin, Gündüz, Mehmet, Karakuş, Volkan, Özlü, Can, Demircioğlu, Sinan, Akay Yanar, Olga Meltem, Özatlı, Düzgün, Ündar, Levent, Tiftik, Eyüp Naci, Türköz Sucak, Ayhan Gülsan, Haznedaroğlu, İbrahim, Özcan, Muhit, Şencan, Mehmet, Tombuloğlu, Murat, Özet, Gülsüm, Bilgir, Oktay, Turgut, Burhan, Özcan, Mehmet Ali, Payzın, Kadriye Bahriye, Sönmez, Mehmet, Ayyıldız, Orhan, Dal, Mehmet Sinan, Ertop, Şehmus, Turgut, Mehmet, Soysal, Teoman, Kaya, Emin, Ünal, Ali, Pehlivan, Mustafa, Atagündüz, Işık, Tuğlular Fıratlı, Tülin, Saydam, Güray, Diz Küçükkaya, Reyhan
• Format: Journal Article
• Language: English
• Published: Turkey Türk Hematoloji Derneği 01.01.2019; Galenos Publishing House
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Benzoates - pharmacology; Benzoates - therapeutic use; Child; Child, Preschool; Chronic Disease; eltrombopag; Female; Humans; Hydrazines - pharmacology; Hydrazines - therapeutic use; immune thrombocytopenic; Male; Middle Aged; Purpura, Thrombocytopenic, Idiopathic - drug therapy; Pyrazoles - pharmacology; Pyrazoles - therapeutic use; thrombocytopenia; Tıp; Young Adult; İstanbul; Türkiye; Thrombocytopenia; Immune thrombocytopenic; Eltrombopag; İdiyopatik trombositopenik purpura; Trombositopeni
• ISSN: 1300-7777; 1308-5263
• DOI: 10.4274/tjh.galenos.2019.2018.0307

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 (/mm ) and defined as complete (platelet count of >100,000/mm ), partial (30,000-100,000/mm or doubling of platelet count after treatment), or unresponsive (<30,000/mm ). 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 1 , 2 , 3 , 4 , and 8 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.