From the Guidelines
Promacta (eltrombopag) should generally not be held during an ITP crisis. During an acute ITP crisis with severe thrombocytopenia and bleeding, Promacta should be continued as it works to increase platelet production, though it may take 1-2 weeks to see significant effects. The immediate management of an ITP crisis typically involves more rapid-acting treatments such as intravenous immunoglobulin (IVIG) at 1g/kg daily for 1-2 days, high-dose corticosteroids like methylprednisolone 1g/day for 3 days, or platelet transfusions for life-threatening bleeding 1. Promacta works by stimulating thrombopoietin receptors to increase platelet production in the bone marrow, providing a sustained increase in platelet counts over time. Abruptly discontinuing Promacta during a crisis could potentially worsen thrombocytopenia as the body has become dependent on this stimulation for platelet production. However, platelet counts should be monitored closely during crisis management, and dosing adjustments may be needed based on the patient's response to emergency treatments.
Some key points to consider in the management of ITP crisis include:
- The use of TPO-RAs, such as Promacta, has been shown to be effective in increasing platelet counts and reducing bleeding events in patients with ITP 1.
- The American Society of Hematology guidelines recommend individualized treatment approaches for patients with ITP, taking into account factors such as duration of ITP, frequency of bleeding episodes, and patient values and preferences 1.
- In patients with life-, limb-, or sight-threatening hemorrhage, treatments such as IVIG, corticosteroids, and platelet transfusions may be considered in addition to Promacta 1.
Overall, the decision to continue or hold Promacta during an ITP crisis should be made on a case-by-case basis, taking into account the individual patient's needs and response to treatment. However, continuing Promacta is generally recommended as it can help to increase platelet production and reduce the risk of bleeding complications.
From the Research
Treatment of ITP with Eltrombopag
- Eltrombopag is a thrombopoietin-receptor agonist used in the treatment of adult chronic immune thrombocytopenia 2, 3, 4, 5, 6.
- It works by increasing the production of platelets, which can help to reduce the risk of bleeding in patients with ITP 2, 3, 4, 5, 6.
Efficacy of Eltrombopag in ITP Treatment
- Studies have shown that eltrombopag is effective in raising platelet counts and reducing bleeding in patients with chronic ITP 3, 6.
- In a Phase III trial, 59% of patients treated with eltrombopag responded to treatment, compared to 16% of patients treated with placebo 6.
- Another Phase III trial found that the odds of responding to treatment were 8 times higher in patients receiving eltrombopag than in those receiving placebo 3, 6.
Safety Considerations
- The most serious adverse effects of eltrombopag are bone marrow fibrosis and hepatotoxicity 5, 6.
- Common adverse effects include nausea and vomiting 6.
- Long-term follow-up studies are needed to fully assess the safety of eltrombopag 3.
Use of Eltrombopag in ITP Crisis
- There is no direct evidence to suggest that eltrombopag should be held during an ITP crisis 2, 3, 4, 5, 6.
- However, the decision to continue or discontinue eltrombopag during an ITP crisis should be made on a case-by-case basis, taking into account the individual patient's condition and medical history 2, 3, 4, 5, 6.