Effect and time of eltrombopag/eltrombopag on increasing platelets

Eltrombopag/Eltrombopag, as an innovative oral small molecule non-peptide TPO-R agonist, has been proven to have significant efficacy in patients with chronic immune thrombocytopenia. It can not only effectively increase the patient's platelet count, but also significantly reduce the occurrence of bleeding events, with an overall effective rate of 60-80%. Eltrombopag is well tolerated and its safety profile is widely recognized.

Eltrombopag has become an ideal treatment option for patients with ITP who have undergone splenectomy and have failed to respond to other treatments (eg, corticosteroids, immunoglobulins) At the same time, eltrombopag can also be considered as a second-line treatment option for adult non-splenectomy patients who refuse surgery or have contraindications for surgery.

When using eltrombopag, the recommended starting dose is 50 mg daily However, in patients of East Asian ancestry, the starting dose should be reduced to 25 mg. After starting treatment, if no significant increase in platelet count is observed within 2-3 weeks, an increase in drug dose may be considered. After the platelet count reaches a steady state at a specific dose, the dose should be further adjusted to the lowest level to maintain the platelet count at approximately 50 × 109/L and minimize bleeding symptoms.

In theEXTEND study, it was found that 4.5% of patients achieved long-term remission (median time 50 weeks) without receiving other ITP treatments after discontinuing eltrombopag. The median time to diagnosis of ITP in these patients was 24 months, and the median duration of eltrombopag treatment was 237 days.

In most patients who respond to eltrombopag, platelet counts usually begin to rise after the first week of treatment and peak during the second week. This feature makes eltrombopag particularly suitable for patients with chronic ITP who require elective surgery. They can start taking eltrombopag at home two weeks before their scheduled surgery, thus avoiding the traditional practice of receiving an intravenous immune globulin (IVIG) infusion before surgery.