Is there any information on combination therapy using IVIg with a TPO agonist such as romiplostim or eltrombopag for ITP?
In the pivotal clinical trials of both romiplostim and eltrombopag, patients were required to have failed one first-line therapy and be on no other or a stable dose of another oral ITP therapy for at least a month prior to enrollment. If IVIg had been used in treatment it had to be last administered at least 2 weeks prior to enrollment. Thus IVIg was not routinely used in these trials other than for rescue therapy. Conventional ITP treatments aim to decrease platelet destruction while the TPO agonists stimulate platelet production. Combining these two therapies may seem an attractive way of treating ITP. The effects of both IVIg and the TPO agonists, however, are only temporary; when either of these drugs is stopped the platelet count will typically return to baseline, unless there was a spontaneous remission of the disease. Thus these drugs would be unlikely to be used as concomitant therapy other than in emergent situations where the response to high- dose steroids or IVIg was subopt
