Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr;102(4):715-727.
doi: 10.1007/s00277-023-05114-8. Epub 2023 Feb 24.

Use of thrombopoietin receptor agonists in adults with immune thrombocytopenia: a systematic review and Central European expert consensus

Dražen Pulanić  1 , Angelika Bátorová  2 , Imre Bodó  3 , Libor Červinek  4 , Ioana Ionita  5 , Toshko Lissitchkov  6 , Anahit Melikyan  7 , Maria Podolak-Dawidziak  8
Affiliations

Use of thrombopoietin receptor agonists in adults with immune thrombocytopenia: a systematic review and Central European expert consensus

Dražen Pulanić et al. Ann Hematol. 2023 Apr.

Abstract

There are currently three thrombopoietin receptor agonists (TPO-RAs) approved in Europe for treating patients with immune thrombocytopenia (ITP): romiplostim (Nplate®), eltrombopag (Revolade®), and avatrombopag (Doptelet®). However, comparative clinical data between these TPO-RAs are limited. Therefore, the purpose of this study was to perform a literature review and seek expert opinion on the relevance and strength of the evidence concerning the use of TPO-RAs in adults with ITP. A systematic search was conducted in PubMed and Embase within the last 10 years and until June 20, 2022. A total of 478 unique articles were retrieved and reviewed for relevance. The expert consensus panel comprised ITP senior hematologists from eight countries across Central Europe. The modified Delphi method, consisting of two survey rounds, a teleconference and email correspondence, was used to reach consensus. Forty articles met the relevancy criteria and are included as supporting evidence, including five meta-analyses analyzing all three European-licensed TPO-RAs and comprising a total of 31 unique randomized controlled trials (RCTs). Consensus was reached on seven statements for the second-line use of TPO-RAs in the management of adult ITP patients. In addition, the expert panel discussed TPO-RA treatment in chronic ITP patients with mild/moderate COVID-19 and ITP patients in the first-line setting but failed to reach consensus. This work will facilitate informed decision-making for healthcare providers treating adult ITP patients with TPO-RAs. However, further studies are needed on the use of TPO-RAs in the first-line setting and specific patient populations.

Keywords: Avatrombopag; Consensus; Eltrombopag; Immune thrombocytopenia; Romiplostim; Systematic review; Thrombopoietin receptor agonists.

PubMed Disclaimer

Conflict of interest statement

DP received honoraria as a member of advisory boards and/or speaker from Novartis, Amgen, and Sobi; AB received honoraria as a member of advisory boards and speaker from Novartis and Sobi; II received honoraria as a member of advisory boards and/or speaker from Novartis, Amgen, Pfizer, Roche, Takeda, Accord, and Sobi; TL has taken part as a Principle Investigator for projects financed by Bayer, CSL Behring, Catalist, Grifols, Octapharma, Pfizer, Sanofi-Alnilam, and Bioverativ, received honoraria as a member of advisory boards from Roche and Sobi, and has received honoraria as a lecturer from Novo Nordisk, Octapharma, Roche, and Sobi; IB declares no conflicts of interest; LC received honoraria as a member of advisory boards and/or speaker from Novartis, Amgen, Alexion, and Sobi; AM received honoraria as a member of advisory boards from Novartis and Sobi and as a speaker from Novartis and Amgen; and M.P-D has received consulting and lecture fees from Alexion, Amgen, CSL-Behring, Novo Nordisk, Novartis, Orphan, Roche, Sanofi, Sobi, Swiss-Pharma, and Takeda and an institutional research grant from Takeda.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
See this image and copyright information in PMC

References

    1. Semple JW, Provan D, Garvey MB, Freedman J (2010) Recent progress in understanding the pathogenesis of immune thrombocytopenia. Curr Opin Hematol 17(6):590–595. 10.1097/moh.0b013e32833eaef3 10.1097/moh.0b013e32833eaef3 - DOI - PubMed
    1. Provan D, Semple JW (2022) Recent advances in the mechanisms and treatment of immune thrombocytopenia. eBioMedicine 76:103820. 10.1016/j.ebiom.2022.103820 - PMC - PubMed
    1. Cooper N, Ghanima W (2019) Immune thrombocytopenia. N Engl J Med 381(10):945–955. 10.1056/NEJMcp1810479 10.1056/NEJMcp1810479 - DOI - PubMed
    1. Terrell DR, Beebe LA, Vesely SK, Neas BR, Segal JB, George JN (2010) The incidence of immune thrombocytopenic purpura in children and adults: a critical review of published reports. Am J Hematol 85(3):174–180. 10.1002/ajh.21616 10.1002/ajh.21616 - DOI - PubMed
    1. Sobas M, Podolak-Dawidziak M, Lewandowski K, Bator M, Wróbel T (2021) Primary immune thrombocytopenia and essential thrombocythemia: so different and yet somehow similar-cases series and a review of the literature. Int J Mol Sci 22(20):10918. 10.3390/ijms222010918 10.3390/ijms222010918 - DOI - PMC - PubMed

Publication types

MeSH terms