Real-world use of thrombopoietin receptor agonists in older patients with primary immune thrombocytopenia

摘要

The efficacy and safety of thrombopoietin receptor agonists (TRAs) in older patients with primary immune thrombocytopenia (ITP) are unknown. We investigated TRA response and switch, thrombotic/hemorrhagic risk, and sustained responses off-treatment (SROTs) in 384 patients with ITP aged >= 60 years. After 3 months, 82.5 and 74.3 of eltrombopag and romiplostim-treated patients, respectively, achieved a response; 66.7 maintained the response (median follow-up, 2.7 years). Eighty-five (22.2) patients switched to the alternative TRA; although no cross-toxicity was observed, 83.3 of resistant patients had a response after the switch. Thirty-four major thromboses (3 fatal) and 14 major hemorrhages (none fatal) occurred in 18 and 10 patients, respectively, while on TRAs and were associated with thrombosis history (subdistribution hazard ratio, 2.04, P = .05) and platelet count = 75 years; 41.1) was associated with the more frequent start of TRAs in the persistent/acute phase but not with response or thrombotic/hemorrhagic risk. TRAs are effective in older patients with ITP, with no fatal hemorrhages and with SROTs in a significant portion of patients. Caution is warranted in patients with a history of thrombosis, and a careful risk/benefit balance should be considered.