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Observational Study
. 2022 May;197(3):359-366.
doi: 10.1111/bjh.18081. Epub 2022 Feb 18.

Adults with immune thrombocytopenia who switched to avatrombopag following prior treatment with eltrombopag or romiplostim: A multicentre US study

Hanny Al-Samkari  1   2 , Debbie Jiang  3   4 , Terry Gernsheimer  3   4 , Howard Liebman  5 , Susie Lee  5 , Matthew Wojdyla  6 , Michael Vredenburg  6 , Adam Cuker  7
Affiliations
Observational Study

Adults with immune thrombocytopenia who switched to avatrombopag following prior treatment with eltrombopag or romiplostim: A multicentre US study

Hanny Al-Samkari et al. Br J Haematol. 2022 May.

Abstract

Patients with immune thrombocytopenia (ITP) may respond to one thrombopoietin receptor agonist (TPO-RA) but not another. Limited data are available describing outcomes in patients who switched from romiplostim or eltrombopag to avatrombopag, a newer oral TPO-RA. We performed a retrospective observational study of adults with ITP who switched from eltrombopag or romiplostim to avatrombopag at four US tertiary ITP referral centres. Forty-four patients were included, with a mean ITP duration of 8.3 years and a median (range) of four prior ITP treatments. On avatrombopag, 41/44 patients (93%) achieved a platelet response (≥50 × 109 /l) and 38/44 patients (86%) achieved a complete response (≥100 × 109 /l). In all patients, the median platelet count on eltrombopag or romiplostim was 45 × 109 /l vs 114 × 109 /l on avatrombopag (p < 0.0001); in patients switched for ineffectiveness of romiplostim/eltrombopag, it was 28 × 109 /l on romiplostim/eltrombopag vs 88 × 109 /l on avatrombopag (p = 0.025). Fifty-seven percent of patients receiving concomitant ITP medications before switching discontinued them after switching, including 63% of patients receiving chronic corticosteroids. In a heavily pretreated chronic ITP population, avatrombopag was effective following therapy with romiplostim or eltrombopag, with high response rates even in patients with inadequate response to a prior TPO-RA.

Keywords: avatrombopag; eltrombopag; immune thrombocytopenia; romiplostim; thrombopoietin receptor agonist.

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Conflict of interest statement

Hanny Al‐Samkari has served as consultant for Agios, Forma, Dova/Sobi, argenx, Rigel, Novartis and Moderna, and his institution has received research support on his behalf from Agios, Dova/Sobi and Amgen. Debbie Jiang has nothing to disclose. Terry Gernsheimer has received honoraria from Amgen, Dova Pharmaceuticals and Novartis; has acted as a consultant for the Platelet Disorder Support Association, Amgen, Dova Pharmaceuticals, Biogen, Momenta, Sanofi, Vertex, Cellphire, Fujifilm, Rigel, Shionogi and Principia; and has received research support from the National Heart, Lung and Blood Institute, Principia, Rigel and Cellphire. Howard Liebman has served as a consultant for Amgen, argenx, Dova/Sobi, Genzyme, Novartis and Sanofi and has received research funding from argenx, Momenta/Janssen and Principia/Sanofi. Susie Lee has nothing to disclose. Matthew Wojdyla is an employee of Swedish Orphan Biovitrum, Inc. Michael Vredenburg is an employee of Swedish Orphan Biovitrum, Inc. Adam Cuker has served as a consultant for Synergy; he has received royalties from UpToDate; and his institution has received research support on his behalf from Alexion, Bayer, Novartis, Novo Nordisk, Pfizer, Sanofi, Spark and Takeda.

Figures

FIGURE 1
FIGURE 1
Median platelet counts for each patient prior to switch (during treatment with romiplostim or eltrombopag) versus following the switch to avatrombopag. For each patient, the median platelet count is the median of the most recent three platelet counts measured while receiving that agent. (A) All patients (N = 44). (B) Patients switched due to ineffectiveness of romiplostim or eltrombopag (N = 14). One patient with a median platelet count of 585 × 109/l on avatrombopag omitted from both graphs to preserve graph resolution. Abbreviations: AVA, avatrombopag; ELT, eltrombopag; PLT, platelet count; ROMI, romiplostim
See this image and copyright information in PMC

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