I have a 68-year-old patient with ITP who has failed steroids, IVIG and splenectomy. Is a thrombopoeisis stimulating drug such as romiplostim or eltrombopag the proper next therapeutic option?
A number of new therapies for ITP have emerged as the result of improved understanding of the immunopathologic mechanisms involved in the disorder. One of these, the use of thrombopoietin (TPO) to increase platelet production, is based on the recognition that neither platelet production nor TPO levels are increased in most patients. TPO is a glycoprotein hormone synthesized in the liver that promotes the viability and growth of megakaryocyte colony-forming cells and megakaryocyte progenitors, thus increasing the production of maturemegakaryocytes and platelets. Recombinant TPO is a viable therapeutic approach, but was found to be associated with the formation of neutralizing antibodies that cross-reacted with endogenous TPO and resulted in thrombocytopenia. Two TPO mimetics, romiplostim (Nplate®) and eltrombopag (Promacta®) were recently approved by the FDA. Romiplostim is an injectable peptide and eltrombopag is an orally available nonpeptide drug. Either of these agents may be a good
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