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.