Glucocorticoids promote response to thrombopoietin-receptor agonists in refractory ITP: a case series
- 206 Downloads
A proportion of patients with immune thrombocytopenic purpura are refractory to multiple therapies including thrombopoietin-receptor agonists (TPO-RA). We report 10 patients who did not respond to a TPO-RA until the addition of a glucocorticoid. These patients were previously treated with a median of 6 therapies. One patient elected to discontinue both medications despite persistent thrombocytopenia. The remaining 9 patients continued on the combination of prednisone (doses 5 mg every other day to 10 mg daily) and a TPO-RA. Combination therapy with low dose glucocorticoid and a TPO-RA may be an option for patients unresponsive to a TPO-RA alone.
KeywordsAutoimmune thrombocytopenia Immune thrombocytopenic purpura Refractory Thrombopoietin-receptor agonists Glucocorticoids
Jacqueline N. Poston receives support from an Institutional Training Grant from the National Heart, Lung, and Blood Institute (T32 HL007093).
JNP and TBG co-wrote the manuscript. JNP analyzed the data.
Compliance with ethical standards
Conflict of interest
Jacqueline N. Poston has no conflicts of interest to disclose. Terry B. Gernsheimer has been a consultant for Amgen and Novartis.
- 2.Saleh MN, Bussel JB, Cheng G, Meyer O, Bailey CK, Arning M, et al. Safety and efficacy of eltrombopag for treatment of chronic immune thrombocytopenia: results of the long-term, open-label EXTEND study. Blood. 2013;121(3):537–45. https://doi.org/10.1182/blood-2012-04-425512.CrossRefPubMedGoogle Scholar
- 5.Sivera P, Ruella M, Gueli A, Hu H, Wade M, Tarella C. Use of the novel thrombopoietin receptor-agonist romiplostim, in combination with steroids and immunoglobulins for the increase of platelets prior to splenectomy, in refractory immune thrombocytopenia: a case report. Blood Coagul Fibrinolysis. 2012;23(4):331–4. https://doi.org/10.1097/MBC.0b013e3283513a97.CrossRefPubMedGoogle Scholar
- 8.Gomez-Almaguer D, Herrera-Rojas MA, Jaime-Perez JC, Gomez-De Leon A, Cantu-Rodriguez OG, Gutierrez-Aguirre CH, et al. Eltrombopag and high-dose dexamethasone as frontline treatment of newly diagnosed immune thrombocytopenia in adults. Blood. 2014;123(25):3906–8. https://doi.org/10.1182/blood-2014-01-549360.CrossRefPubMedGoogle Scholar
- 11.Carpenedo M, Cantoni S, Coccini V, Pogliani EM, Cairoli R. Response loss and development of neutralizing antibodies during long-term treatment with romiplostim in patients with immune thrombocytopenia: a case series. Eur J Haematol. 2016;97(1):101–3. https://doi.org/10.1111/ejh.12733.CrossRefPubMedGoogle Scholar
- 12.Handin RI, Stossel TP. Effect of corticosteroid therapy on the phagocytosis of antibody-coated platelets by human leukocytes. Blood. 1978;51(5):771 LP–779.Google Scholar