Real-world use of thrombopoietin receptor agonists in elderly patients with primary immune thrombocytopenia

Elena Rossi, Valerio De Stefano, Francesca Palandri, Daniela Bartoletti, Antonietta Ferretti, Marco Ruggeri, Elisa Lucchini, Valentina Carrai, Wilma Barcellini, Andrea Patriarca, Elena Rivolti, Ugo Consoli, Silvia Cantoni, Esther Natalie Oliva, Federico Chiurazzi, Giovanni Caocci, Gaetano Giuffrida, Alessandra Borchiellini, Giuseppe Auteri, Erminia BaldacciGiuseppe Carli, Daniela Nicolosi, Emanuele Sutto, Monica Carpenedo, Michele Cavo, Maria Gabriella Mazzucconi, Francesco Zaja, Francesco Rodeghiero, Nicola Vianelli

Research output: Contribution to journalArticle


The efficacy and safety of thrombopoietin-receptor agonists (TRAs) in elderly patients with primary immune thrombocytopenia (ITP) is uncertain. In 384 ITP patients treated with TRAs when aged ≥60 years, we investigated TRAs response and switch, thrombotic/hemorrhagic risk, and sustained responses off-treatment (SROT). After 3 months, 82.5% and 74.3% of eltrombopag and romiplostim-treated patients achieved a response, respectively (p=0.09); 66.7% maintained the response (median follow-up: 2.7 years). Eighty-five (22.2%) patients switched to the alternative TRA; while no cross-toxicity was observed, 83.3% of resistant patients had a response after the switch. During TRA, 34 major thromboses (3 fatal) and 14 major hemorrhages (none fatal) occurred in 18 and 10 patients, respectively, and were associated with thrombosis history (SHR: 2.04, p=0.05) and platelet count <20x109/L at TRA start (SHR: 1.69, p=0.04), respectively. A recurrent event occurred in 15.6% of patients surviving thrombosis, in all cases but one during persisting TRA treatment (incidence rate: 7.7 per 100 patient-years). All recurrences occurred in the absence of adequate antithrombotic secondary prophylaxis. Sixty-two (16.5%) responding patients discontinued TRA; 53 (13.8%) patients maintained SROT, which was associated with TRA discontinuation in complete response (p<0.001). Very old age (≥75, 41.1%) was associated with more frequent TRAs start in persistent/acute phase but not with response or thrombotic/hemorrhagic risk. TRAs are effective in elderly ITP patients, with no fatal haemorrhages and with SROT in a significant portion of patients; in patients with thrombosis history caution is warranted and a careful risk/benefit balance should be carried out.
Original languageEnglish
Pages (from-to)N/A-N/A/A
Publication statusPublished - 2021


  • Immune Thrombocytopenia


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