Eltrombopag in chronic idiopathic thrombocytopenic purpura and HCV-related thrombocytopenia.

Platelets play a pivotal role in maintaining hemostatic competence. Thrombocytopenia, irrespective of its etiology, is associated with a risk for bleeding. Treatment modalities for chronic idiopathic thrombocytopenic purpura (ITP) are numerous, but the response is variable, often disappointing and associated with high risks. Better understanding of the pathophysiology of chronic ITP, indicating impaired platelet production rather than simply increased turnover, led to clinical trials aimed at increasing platelet production with thrombopoietin receptor agonists. To date, two compounds have been investigated extensively, romiplostim (AMG-531, Nplate) and eltrombopag (SB-497115, Promacta, Revolade). The success of this treatment further paved the way for evaluating its efficacy in raising platelet counts in hepatitis C virus (HCV)-related infection and myelodysplastic syndrome. Although there is less experience in hepatitis C than in chronic ITP, preliminary data are highly promising. This review will focus on the experience gained with eltrombopag in chronic ITP and HCV-related thrombocytopenia.