González-Porras José R, Godeau Bertrand, Carpenedo Monica
Department of Hematology, IBSAL-Hospital Universitario de Salamanca, 1ª Planta. Paseo de San Vicente, 58-182, 37007, Salamanca, Spain.
Henri Mondor University Hospital, Creteil, France.
Ther Adv Hematol. 2019 May 9;10:2040620719837906. doi: 10.1177/2040620719837906. eCollection 2019.
Primary immune thrombocytopenia (ITP) is a bleeding disorder that conventionally has been treated with steroids or other immunosuppressive treatments. The introduction of thrombopoietin receptor agonists (TPO-RAs), which increase platelet production, dramatically changed the treatment landscape for ITP by providing patients with well-tolerated, long-term treatment options. Two TPO-RAs, eltrombopag and romiplostim, have been approved in the United States and European Union for the treatment of ITP. Some patients do not benefit from the first TPO-RA they receive, so it is assumed that the alternate TPO-RA would have the same outcome. However, eltrombopag and romiplostim have distinct pharmacodynamic and pharmacokinetic properties and may have different tolerability and efficacy in individual patients with ITP. Published retrospective studies showed that >75% of patients who switched to the alternate TPO-RA maintained or achieved a response with the new treatment. Notably, most patients who switched due to lack of efficacy with the first TPO-RA responded to the alternate TPO-RA, which demonstrates an absence of cross-resistance between the two drugs. Therefore, switching to the alternate TPO-RA if the first TPO-RA fails to demonstrate a response should be considered before the use of a less-preferable option.
原发性免疫性血小板减少症（ITP）是一种出血性疾病，传统上一直用类固醇或其他免疫抑制疗法进行治疗。血小板生成素受体激动剂（TPO-RAs）的引入增加了血小板的生成，通过为患者提供耐受性良好的长期治疗选择，极大地改变了ITP的治疗格局。两种TPO-RAs，艾曲泊帕和罗米司亭，已在美国和欧盟获批用于治疗ITP。一些患者并未从他们接受的第一种TPO-RA中获益，因此推测换用另一种TPO-RA会有相同的结果。然而，艾曲泊帕和罗米司亭具有不同的药效学和药代动力学特性，在个别ITP患者中可能具有不同的耐受性和疗效。已发表的回顾性研究表明，>75%换用另一种TPO-RA的患者在新治疗中维持或实现了反应。值得注意的是，大多数因第一种TPO-RA缺乏疗效而换药的患者对另一种TPO-RA有反应，这表明两种药物之间不存在交叉耐药性。因此，在使用不太理想的选择之前，应考虑如果第一种TPO-RA未能显示出反应则换用另一种TPO-RA。
