TY - JOUR
T1 - Alternate use of thrombopoietin receptor agonists in adult primary immune thrombocytopenia patients: A retrospective collaborative survey from Italian hematology centers
AU - Cantoni, Silvia
AU - Carpenedo, Monica
AU - Mazzucconi, Maria Gabriella
AU - De Stefano, Valerio
AU - Carrai, Valentina
AU - Ruggeri, Marco
AU - Specchia, Giorgina
AU - Vianelli, Nicola
AU - Pane, Fabrizio
AU - Consoli, Ugo
AU - Artoni, Andrea
AU - Zaja, Francesco
AU - D'Adda, Mariella
AU - Visentin, Andrea
AU - Ferrara, Felicetto
AU - Barcellini, Wilma
AU - Caramazza, Domenica
AU - Baldacci, Erminia
AU - Rossi, Elena
AU - Ricco, Alessandra
AU - Ciminello, Angela Maria
AU - Rodeghiero, Francesco
AU - Nichelatti, Michele
AU - Cairoli, Roberto
PY - 2018
Y1 - 2018
N2 - Sequential use of the TPO-RAs romiplostim and eltrombopag in ITP patients failing either agent was retrospectively evaluated to assess efficacy and impact of clinical characteristics on outcome. Patients were grouped into 5 categories: efficacy issues: 1st TPO-RA failure; loss of response; non-efficacy issues: platelet fluctuations; patient's preference; adverse event development. Either one TPO-RA sequence was analyzed at 3 month and at last follow-up. 106/546 patients on TPO-RA underwent switch and 65% achieved, regained or maintained a short- term response independent of switch sequence, gender or age; lower response rates were associated with lines of previous therapy; disease duration lowers probability to respond. Clinically, patients switched for efficacy issue did not differ from those switched for non-efficacy issues. Response was achieved/regained in 57.8% of patients switched for efficacy issues, the lowest response rates were observed in non-responders to 1st TPO-RA; 80% of patients switched for non-efficacy issues maintained a response. Platelet fluctuation resolved in 44.4%. Of the 49 patients evaluable for long-term outcome, 27 were in response on therapy; 16 discontinued the TPO-RA for reasons other than efficacy, while only 6 were non responders. We confirm the efficacy of TPO-RA switch; once achieved, response to the 2nd TPO-RA seems durable.
AB - Sequential use of the TPO-RAs romiplostim and eltrombopag in ITP patients failing either agent was retrospectively evaluated to assess efficacy and impact of clinical characteristics on outcome. Patients were grouped into 5 categories: efficacy issues: 1st TPO-RA failure; loss of response; non-efficacy issues: platelet fluctuations; patient's preference; adverse event development. Either one TPO-RA sequence was analyzed at 3 month and at last follow-up. 106/546 patients on TPO-RA underwent switch and 65% achieved, regained or maintained a short- term response independent of switch sequence, gender or age; lower response rates were associated with lines of previous therapy; disease duration lowers probability to respond. Clinically, patients switched for efficacy issue did not differ from those switched for non-efficacy issues. Response was achieved/regained in 57.8% of patients switched for efficacy issues, the lowest response rates were observed in non-responders to 1st TPO-RA; 80% of patients switched for non-efficacy issues maintained a response. Platelet fluctuation resolved in 44.4%. Of the 49 patients evaluable for long-term outcome, 27 were in response on therapy; 16 discontinued the TPO-RA for reasons other than efficacy, while only 6 were non responders. We confirm the efficacy of TPO-RA switch; once achieved, response to the 2nd TPO-RA seems durable.
KW - Thrombopoietin receptor agonists, Immune thrombocytopenia
KW - Thrombopoietin receptor agonists, Immune thrombocytopenia
UR - http://hdl.handle.net/10807/114790
UR - http://onlinelibrary.wiley.com/journal/10.1002/(issn)1096-8652
U2 - 10.1002/ajh.24935
DO - 10.1002/ajh.24935
M3 - Article
SN - 0361-8609
VL - 93
SP - 58
EP - 64
JO - American Journal of Hematology
JF - American Journal of Hematology
ER -