THROMBOPOIETIN RECEPTOR AGONIST SWITCH IN ADULT PRIMARY IMMUNE THROMBOCYTOPENIA (ITP) PATIENTS: A RETROSPECTIVE COLLABORATIVE SURVEY FROM 4 SPANISH CENTERS.
(Abstract release date: 05/19/16)
EHA Library. Lakhwani Lakhwani S. 06/09/16; 134978; PB2078
Dr. Sunil Lakhwani Lakhwani
Contributions
Contributions
Abstract
Abstract: PB2078
Type: Publication Only
Background
Thrombopoietin receptor agonists (TRA), romiplostim (ROM) and eltrombopag (ELT), have changed in the last years the treatment of ITP showing that there is both a increased platelet destruction and a suboptimal platelet production in ITP. Although both drugs activate the same receptor, mechanism of action is different and they don’t activate the same intracellular signalling pathways. That explains why some patients respond to one and not to the other TRA and also the different side effect profile. There are few data evaualting the TRA switch in ITP.
Aims
To describe the reasons and the result of TRA switching in adult ITP patients of the four main centers of our region (Canary Islands) in Spain.
Methods
We retrospectively analized a total of 26 adult patients with ITP who were switched from ROM to ELT or vice versa. Clinical and biological parameters were recorded.
Results
Our series comprise 10 men and 16 women with a mean age of 55 years (range 16-84) when they received the first TRA. All the patients received steroids as the first line treatment. Before starting the first TRA, 9 patients (35%) received Rituximab, 7 patients (27%) received anti-D immunoglobulin, 5 patients (19%) received azatioprine, and only 8 patients (31%) had splenectomy performed. The mean number of previous lines before the first TRA was 2.7 (range 1-4), and 9 patients (35%) received a TRA as second line. ROM was the first TRA in 17 patients who switched to ELT with a median time of 8,8 months. In 9 patients ELT was the first TRA and median time to switch to ROM was 3,4 months. The main reasons for switching were lack of efficacy (n=10), patient’s preference (n=8), side effects (n=5) and platelet-count fluctuation (n=3). The following table shows what happened in each of these situations.
When switch was due to inefficacy, all the cases who received ROM first responded to ELT but only 66% of the patients who received ELT first reponded to ROM. Conspicuously the average of ROM maximum dose was only 4,5 μg/kg/week, very far from the maximum recomended dose (MRD), while the average of ELT maximum dose was 70 mg/day, very near to the MRD. All the changes due to patient preference were from ROM to ELT because of the route of administration. All the patients who switched due to side effects responded to both TRA. Three patients switched from ROM to ELT because platelet-count fluctuation with poor outcome: one did not respond and two responded to ELT but count fluctuation persisted. Six responders patients to the second TRA are now without treatment: four patients achieved a complete response with the second TRA and two patients underwent splenectomy after second TRA and they also achieved a complete response.
Conclusion
As previously reported, in our series we can observe that:-When the patient respond to the first TRA and the switch is not due to inefficacy there is a high probability of responding to the second TRA (100% in our series).-When the switch is motivated by lack of efficacy, the patient could respond to the second TRA specially if the first TRA dose is bellow the MRD.
Session topic: E-poster
Keyword(s): ITP, TPO
Type: Publication Only
Background
Thrombopoietin receptor agonists (TRA), romiplostim (ROM) and eltrombopag (ELT), have changed in the last years the treatment of ITP showing that there is both a increased platelet destruction and a suboptimal platelet production in ITP. Although both drugs activate the same receptor, mechanism of action is different and they don’t activate the same intracellular signalling pathways. That explains why some patients respond to one and not to the other TRA and also the different side effect profile. There are few data evaualting the TRA switch in ITP.
Aims
To describe the reasons and the result of TRA switching in adult ITP patients of the four main centers of our region (Canary Islands) in Spain.
Methods
We retrospectively analized a total of 26 adult patients with ITP who were switched from ROM to ELT or vice versa. Clinical and biological parameters were recorded.
Results
Our series comprise 10 men and 16 women with a mean age of 55 years (range 16-84) when they received the first TRA. All the patients received steroids as the first line treatment. Before starting the first TRA, 9 patients (35%) received Rituximab, 7 patients (27%) received anti-D immunoglobulin, 5 patients (19%) received azatioprine, and only 8 patients (31%) had splenectomy performed. The mean number of previous lines before the first TRA was 2.7 (range 1-4), and 9 patients (35%) received a TRA as second line. ROM was the first TRA in 17 patients who switched to ELT with a median time of 8,8 months. In 9 patients ELT was the first TRA and median time to switch to ROM was 3,4 months. The main reasons for switching were lack of efficacy (n=10), patient’s preference (n=8), side effects (n=5) and platelet-count fluctuation (n=3). The following table shows what happened in each of these situations.
| Reason for change | Group | First TRA | Second TRA response |
| Inefficacy10 patients | 4 ROM →ELT | ROM average dose4,5 μg/kg/week | 100% resp. ELT |
| 6 ELT → ROM | ELT average dose70 mg/d | 66% resp. ROM | |
| Pat. preference8 patients | 8 ROM → ELT | 100% resp. ROM | 100% resp. ELT |
| Side effect5 patients | 2 ROM → ELT | -Headache | 100% resp. ELT |
| 2 ELT → ROM | -Dermatitis-Diarrhea-Transaminase elev. | 100% resp. ROM | |
| Count fluctuation3 patients | 3 ROM → ELT | -33% no response ELT-66% resp. ELT with count fluctuation | |
Conclusion
As previously reported, in our series we can observe that:-When the patient respond to the first TRA and the switch is not due to inefficacy there is a high probability of responding to the second TRA (100% in our series).-When the switch is motivated by lack of efficacy, the patient could respond to the second TRA specially if the first TRA dose is bellow the MRD.
Session topic: E-poster
Keyword(s): ITP, TPO
Abstract: PB2078
Type: Publication Only
Background
Thrombopoietin receptor agonists (TRA), romiplostim (ROM) and eltrombopag (ELT), have changed in the last years the treatment of ITP showing that there is both a increased platelet destruction and a suboptimal platelet production in ITP. Although both drugs activate the same receptor, mechanism of action is different and they don’t activate the same intracellular signalling pathways. That explains why some patients respond to one and not to the other TRA and also the different side effect profile. There are few data evaualting the TRA switch in ITP.
Aims
To describe the reasons and the result of TRA switching in adult ITP patients of the four main centers of our region (Canary Islands) in Spain.
Methods
We retrospectively analized a total of 26 adult patients with ITP who were switched from ROM to ELT or vice versa. Clinical and biological parameters were recorded.
Results
Our series comprise 10 men and 16 women with a mean age of 55 years (range 16-84) when they received the first TRA. All the patients received steroids as the first line treatment. Before starting the first TRA, 9 patients (35%) received Rituximab, 7 patients (27%) received anti-D immunoglobulin, 5 patients (19%) received azatioprine, and only 8 patients (31%) had splenectomy performed. The mean number of previous lines before the first TRA was 2.7 (range 1-4), and 9 patients (35%) received a TRA as second line. ROM was the first TRA in 17 patients who switched to ELT with a median time of 8,8 months. In 9 patients ELT was the first TRA and median time to switch to ROM was 3,4 months. The main reasons for switching were lack of efficacy (n=10), patient’s preference (n=8), side effects (n=5) and platelet-count fluctuation (n=3). The following table shows what happened in each of these situations.
When switch was due to inefficacy, all the cases who received ROM first responded to ELT but only 66% of the patients who received ELT first reponded to ROM. Conspicuously the average of ROM maximum dose was only 4,5 μg/kg/week, very far from the maximum recomended dose (MRD), while the average of ELT maximum dose was 70 mg/day, very near to the MRD. All the changes due to patient preference were from ROM to ELT because of the route of administration. All the patients who switched due to side effects responded to both TRA. Three patients switched from ROM to ELT because platelet-count fluctuation with poor outcome: one did not respond and two responded to ELT but count fluctuation persisted. Six responders patients to the second TRA are now without treatment: four patients achieved a complete response with the second TRA and two patients underwent splenectomy after second TRA and they also achieved a complete response.
Conclusion
As previously reported, in our series we can observe that:-When the patient respond to the first TRA and the switch is not due to inefficacy there is a high probability of responding to the second TRA (100% in our series).-When the switch is motivated by lack of efficacy, the patient could respond to the second TRA specially if the first TRA dose is bellow the MRD.
Session topic: E-poster
Keyword(s): ITP, TPO
Type: Publication Only
Background
Thrombopoietin receptor agonists (TRA), romiplostim (ROM) and eltrombopag (ELT), have changed in the last years the treatment of ITP showing that there is both a increased platelet destruction and a suboptimal platelet production in ITP. Although both drugs activate the same receptor, mechanism of action is different and they don’t activate the same intracellular signalling pathways. That explains why some patients respond to one and not to the other TRA and also the different side effect profile. There are few data evaualting the TRA switch in ITP.
Aims
To describe the reasons and the result of TRA switching in adult ITP patients of the four main centers of our region (Canary Islands) in Spain.
Methods
We retrospectively analized a total of 26 adult patients with ITP who were switched from ROM to ELT or vice versa. Clinical and biological parameters were recorded.
Results
Our series comprise 10 men and 16 women with a mean age of 55 years (range 16-84) when they received the first TRA. All the patients received steroids as the first line treatment. Before starting the first TRA, 9 patients (35%) received Rituximab, 7 patients (27%) received anti-D immunoglobulin, 5 patients (19%) received azatioprine, and only 8 patients (31%) had splenectomy performed. The mean number of previous lines before the first TRA was 2.7 (range 1-4), and 9 patients (35%) received a TRA as second line. ROM was the first TRA in 17 patients who switched to ELT with a median time of 8,8 months. In 9 patients ELT was the first TRA and median time to switch to ROM was 3,4 months. The main reasons for switching were lack of efficacy (n=10), patient’s preference (n=8), side effects (n=5) and platelet-count fluctuation (n=3). The following table shows what happened in each of these situations.
| Reason for change | Group | First TRA | Second TRA response |
| Inefficacy10 patients | 4 ROM →ELT | ROM average dose4,5 μg/kg/week | 100% resp. ELT |
| 6 ELT → ROM | ELT average dose70 mg/d | 66% resp. ROM | |
| Pat. preference8 patients | 8 ROM → ELT | 100% resp. ROM | 100% resp. ELT |
| Side effect5 patients | 2 ROM → ELT | -Headache | 100% resp. ELT |
| 2 ELT → ROM | -Dermatitis-Diarrhea-Transaminase elev. | 100% resp. ROM | |
| Count fluctuation3 patients | 3 ROM → ELT | -33% no response ELT-66% resp. ELT with count fluctuation | |
Conclusion
As previously reported, in our series we can observe that:-When the patient respond to the first TRA and the switch is not due to inefficacy there is a high probability of responding to the second TRA (100% in our series).-When the switch is motivated by lack of efficacy, the patient could respond to the second TRA specially if the first TRA dose is bellow the MRD.
Session topic: E-poster
Keyword(s): ITP, TPO
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