Department of Internal Medicine, Centre Hospitalier Universitaire (CHU) Henri-Mondor, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris-Est Créteil (UPEC), Créteil, France.
Haematologica. 2013 Jun;98(6):881-7. doi: 10.3324/haematol.2012.074633. Epub 2013 Feb 26.
Romiplostim and eltrombopag, the first thrombopoietic receptor-agonists with demonstrated efficacy against immune thrombocytopenia in prospective controlled studies, were recently authorized in most countries for adults with chronic immune thrombocytopenia. So far, no data are available about the potential contribution of switching from romiplostim to eltrombopag or vice versa in terms of efficacy or tolerance. Efficacies and tolerance profiles were evaluated for 46 patients who sequentially received both drugs, switching from one to the other. The reasons for switching were: lack of efficacy for 23 patients, platelet-count fluctuations for 11, side effects for 4, and 8 patients' preferences. For 50-80% of the patients, switching from romiplostim to eltrombopag or eltrombopag to romiplostim effectively impacted the platelet count, with fluctuations disappearing in 54% and side effects resolved in 100%. In 80% of the patients, the 2 thrombopoietic receptor-agonists achieved similar response patterns. Our results confirmed that switching from one thrombopoietic receptor-agonist to the other could be beneficial in clinical practice for patients with severe chronic immune thrombopenia who failed to respond or experienced adverse events to the first. (Clinical Trials.gov identifier: NCT01618734).
罗米司亭和艾曲泊帕是首批在前瞻性对照研究中证实对免疫性血小板减少症有效的促血小板生成素受体激动剂，最近已在大多数国家获得批准用于治疗成人慢性免疫性血小板减少症。迄今为止，尚无关于从罗米司亭转换为艾曲泊帕或反之在疗效或耐受性方面潜在获益的相关数据。我们评估了 46 例先后接受这两种药物治疗的患者的疗效和耐受性，他们从一种药物转换为另一种药物。转换的原因包括：23 例患者疗效不佳、11 例血小板计数波动、4 例出现副作用以及 8 例患者偏好。对于 50%-80%的患者，从罗米司亭转换为艾曲泊帕或从艾曲泊帕转换为罗米司亭可有效影响血小板计数，其中 54%的患者血小板计数波动消失，100%的患者副作用得到缓解。在 80%的患者中，这两种促血小板生成素受体激动剂的反应模式相似。我们的结果证实，对于那些对第一种药物反应不佳或出现不良反应的严重慢性免疫性血小板减少症患者，从一种促血小板生成素受体激动剂转换为另一种药物在临床实践中可能是有益的。（临床试验注册编号：NCT01618734）。
