Abstract
Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by platelet count less than 100×109/L and an increased risk of bleeding. The risk of bleeding increases in proportion with the degree of thrombocytopenia. Although several medications are used for primary thrombocytopenia treatment, refractoriness remains a concern. Romiplostim and eltrombopag, two relatively new drugs, have been shown to be successful in ITP treatment after standard treatment failure. The current guidelines recommend their use as a second-line treatment. In this article, we have tried to compare which of these two medications is the best option considering clinical effectiveness, cost-effectiveness, adverse effects, and the possibility of switching between them in case of ineffectiveness. The studies used in this article were found in the PubMed database. All the studies are limited to adults. Based on these studies, both medications seem to be a largely effective, safe option. Romiplostim appears to have slightly fewer adverse effects and higher costs. Switching between thrombopoietin receptor agonists (TRAs) is a successful way to overcome adverse effects and inadequacy according to the currently available literature. We believe that more detailed studies are needed to determine which of these drugs should be considered the first choice, to report long term efficacy and adverse effects, and to determine if treatment guidelines can change regarding the use of TRAs as first-line treatment.
Highlights
BackgroundImmune thrombocytopenia (ITP) is a condition of low platelet count, in which platelets are destroyed by the immune system, with an estimated incidence of 2-4/100000 adults/year [1,2]
Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by platelet count less than 100×109/L and an increased risk of bleeding
We believe that more detailed studies are needed to determine which of these drugs should be considered the first choice, to report long term efficacy and adverse effects, and to determine if treatment guidelines can change regarding the use of thrombopoietin receptor agonists (TRAs) as first-line treatment
Summary
Immune thrombocytopenia (ITP) is a condition of low platelet count (less than 100×109/L), in which platelets are destroyed by the immune system, with an estimated incidence of 2-4/100000 adults/year [1,2]. A significant increase in platelet counts and a decrease in bleeding were reported in 80% of patients treated with eltrombopag by the end of the second week [23]. Tomiyama et al studied 15 Japanese patients in a six-week study, with platelet counts less than 30×109/L and from whom 69% were splenectomized [26] They reported a response to treatment in 60% of patients, decreased bleeding, and a lower eltrombopag dose to be effective in Japanese patients [26]. Liver function test abnormalities are mainly seen in patients treated with eltrombopag, and no significant changes are reported in patients on romiplostim Neither of these two agents is associated with significantly increased rates of severe adverse effects. In the USA, the studies oppose each other, but based on the cost per eltrombopag tablet and romiplostim vial, we conclude that romiplostim cost is higher
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