Thrombopoietin Receptor Agonists in the Treatment of Chronic Resistant Primary Immune Thrombocytopenia: Efficacy and Safety Data in Real Clinical Practice

  • Authors: PTUSHKIN VV1,2,3, VINOGRADOVA OY.1,2,3, PANKRASHKINA MM4,5,6, CHERNIKOV MV4,6, ARSHANSKAYA EG4,5, TKACHENKO NE5
  • Affiliations:
    1. The City Clinical Hospital named after S.P. Botkin Moscow Department of Health, Moscow, Russia
    2. National Medical Research Center of Children's Hematology, Oncology and Immunology named after Dmitry Rogachev of the Russian Federation Ministry of Health, Moscow, Russia
    3. Russian National Medical Research University named after N.I. Pirogov, Russian Federation Ministry of Health
    4. The City Clinical Hospital named after S.P. Botkin Moscow Department of Health
    5. National Medical Research Center of Children's Hematology, Oncology and Immunology named after Dmitry Rogachev of the Russian Federation Ministry of Health
    6. Healthcare and Medical Management Research Institute of the Moscow City Health Department
  • Issue: Vol 90, No 7 (2018)
  • Pages: 70-76
  • Section: Editorial
  • URL: https://journals.rcsi.science/0040-3660/article/view/32785
  • DOI: https://doi.org/10.26442/terarkh201890770-76
  • ID: 32785

Cite item

Full Text

Abstract

Objective: To analyze the long-term efficacy and safety of ATR in adult patients with primary resistant ITP in real-world clinical practice. Materials and methods.The article contains long-term results analysis of ATR application under real clinical practice conditions in 138 patients (40 men and 98 women) whose median age at the beginning of therapy was 59 (18-86) years. Two ATR medicines-romiplostim (100 patients) and eltrombopag (38 patients) were used. Results. During the first month of therapy, the median platelet count in the romiplostim group increased from 17·109 / L to 60·109 / L (9-600·109 / L), and the elethrombopag from 16.109 / L to 56.109 / L (9-400·109 / L). The minimal response (reaching platelet counts over 30·109 / L) was achieved in 92% of cases in both groups. Partial response (achievement of platelet count more than 50·109 / L) was achieved in 91 and 84% of patients in the rhombostim and eltrombopag groups, respectively. The frequency of complete response (an increase in platelet counts above 100·109 / L) was noted somewhat more often in the rhyploistim group-69% compared to 47% in the eltrombopag group (P = NS). Most patients demonstrated a long-term stable effect in the form of an increase in blood platelet count to a safe level during months and years of ATR treatment. The achievement of at least partial remission for 3 months or more was 70 and 71% in romiplostim and elthrombopag groups, respectively. Patients who started ATR- therapy are currently continuing treatment: 51% - in romiplostim group and in eltrombopag group-39%. The main reason of discontinuation the initially effective therapy were the loss of platelet response, toxicity, withdrawal from treatment (withdrawal with preservation of remission) and patients death. The tolerability of drugs with long-term admission was satisfactory. The most common AE were headache, bone pain, thrombosis, increased blood pressure and petechial hemorrhagic eruptions. The overall incidence of complications did not differ significantly between the romiplostim and eltrombopag groups -15.6 and 15.8%, respectively. Conclusion. Long-term ATR-therapy using in patients with resistant chronic ITP is an effective and largely safe treatment option.

About the authors

V V PTUSHKIN

The City Clinical Hospital named after S.P. Botkin Moscow Department of Health, Moscow, Russia; National Medical Research Center of Children's Hematology, Oncology and Immunology named after Dmitry Rogachev of the Russian Federation Ministry of Health, Moscow, Russia; Russian National Medical Research University named after N.I. Pirogov, Russian Federation Ministry of Health

д.м.н, проф., зам. главного врача по гематологии ГБУЗ «Городская клиническая больница им. С.П.Боткина» ДЗМ, проф. каф. онкологии, гематологии и лучевой терапии ГБОУ ВПО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» МЗ России, зав. отделом кооперированных исследований гематологических заболеваний у подростков и взрослых ФГБУ «Национальный научно- практический центр детской гематологии, онкологии и лучевой терапии им. Дмитрия Рогачева» МЗ России Moscow, Russia

O Yu VINOGRADOVA

The City Clinical Hospital named after S.P. Botkin Moscow Department of Health, Moscow, Russia; National Medical Research Center of Children's Hematology, Oncology and Immunology named after Dmitry Rogachev of the Russian Federation Ministry of Health, Moscow, Russia; Russian National Medical Research University named after N.I. Pirogov, Russian Federation Ministry of Health

д.м.н, руководитель Московского городского гематологического центра ГБУЗ «Городская клиническая больница им. С.П.Боткина» ДЗМ, проф. каф. онкологии, гематологии и лучевой терапии ГБОУ ВПО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» МЗ России, г.н.с. отдела кооперированных исследований гематологических заболеваний у подростков и взрослых ФГБУ «Национальный научно-практический центр детской гематологии, онкологии и лучевой терапии им. Дмитрия Рогачева» МЗ России Moscow, Russia

M M PANKRASHKINA

The City Clinical Hospital named after S.P. Botkin Moscow Department of Health; National Medical Research Center of Children's Hematology, Oncology and Immunology named after Dmitry Rogachev of the Russian Federation Ministry of Health; Healthcare and Medical Management Research Institute of the Moscow City Health Department

м.н., врач-гематолог Московского городского гематологического центра ГБУЗ «Городская клиническая больница им. С.П. Боткина» ДЗМ, н.с. отдела кооперированных исследований гематологических заболеваний у подростков и взрослых ФГБУ «Национальный научно-практический центр детской гематологии, онкологии и лучевой терапии им. Дмитрия Рогачева» МЗ России, врач-методист организационно-методического отдела по гематологии Научно-исследовательского института организации здравоохранения и медицинского менеджмента Департамента здравоохранения города Москвы Moscow, Russia

M V CHERNIKOV

The City Clinical Hospital named after S.P. Botkin Moscow Department of Health; Healthcare and Medical Management Research Institute of the Moscow City Health Department

программист организационно-методического отдела по гематологии, Научно-исследовательский институт организации здравоохранения и медицинского менеджмента Департамента здравоохранения города Москвы, ГБУЗ Городская клиническая больница им. С.П. Боткина Департамента здравоохранения города Москвы Moscow, Russia

E G ARSHANSKAYA

The City Clinical Hospital named after S.P. Botkin Moscow Department of Health; National Medical Research Center of Children's Hematology, Oncology and Immunology named after Dmitry Rogachev of the Russian Federation Ministry of Health

к.м.н., врач-гематолог Московского городского гематологического центра ГБУЗ «Городская клиническая больница им. С.П. Боткина» ДЗМ, н.с. отдела кооперированных исследований гематологических заболеваний у подростков и взрослых ФГБУ «Национальный научно-практический центр детской гематологии, онкологии и лучевой терапии им. Дмитрия Рогачева» МЗ России Moscow, Russia

N E TKACHENKO

National Medical Research Center of Children's Hematology, Oncology and Immunology named after Dmitry Rogachev of the Russian Federation Ministry of Health

н.с. отдела кооперированных исследований гематологических заболеваний у подростков и взрослых ФГБУ «Национальный научно-практический центр детской гематологии, онкологии и лучевой терапии им. Дмитрия Рогачева» МЗ России; тел.:+7(916)326-40-41 Moscow, Russia

References

  1. Mc Millan R, Wang L, Tani P. Prospective evaluation of the immunobead assay for the diagnosis of adult chronic immune thrombocytopenic purpura (ITP). J Thromb Haemost. 2003;1:485-91.
  2. Olsson B, Andersson P.O, Jernas M et al. T-cell - mediated cytotoxicity toward platelets in chronic idiopathic thrombocytopenic purpura. Nat Med. 2003; 9:1123-4.
  3. Houwerzijl E.J, Blom N.R, van der Want J.J et al. Ultrastructural study shows morphologic features of apoptosis and para - apoptosis in megakaryocytes from patients with idiopathic thrombocytopenic purpura. Blood. 2004;103:500-6.
  4. Kuter D.J, Bussel J.B, Lyons R.M et al. Efficacy of romiplostim in patients with chronic immune thrombocytopenic purpura: a double - blind randomized controlled trial. Lancet. 2008; 371:395-403.
  5. Cheng G, Saleh M.N, Marcher C et al. Eltrombopag for management of chronic immune thrombocytopenia (RAISE): a 6-month, randomized, phase 3 study. Lancet. 2010.
  6. Saleh M.N, Bussel J.B, Cheng G et al. Long-Term Treatment of Chronic Immune Thrombocytopenic Purpura with Oral Eltrombopag: Results From the EXTEND Study. ASH Annual Meeting Abstracts. 2009; 114:682.
  7. Kuter D.J, Bussel J.B, Newland A et al. Long - term treatment with romiplostim in patients with chronic immune thrombocytopenia: safety and efficacy. Br J Haematol. 2013 May; 161(3):411-23.
  8. Птушкин В.В., Миненко С.В., Биячуев Э.Р., Пшонкин А.В., Шубина А.В. Лечение больных с резистентной иммунной тромбоцитопенией: обзор литературы и клинические наблюдения. Онкогематология. 2011; 6(1):56-63. doi: 10.17650/1818-8346-2011-6-1-56-63

Copyright (c) 2018 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies