How long does it take for Eltrombopag/Eltrombopag to increase platelets?

Eltrombopag/Eltrombopag is an oral small molecule non-peptide TPO-R agonist. It has been shown to be effective in increasing platelet counts and reducing bleeding symptoms in patients with chronicimmune thrombocytopenia, with an overall effectiveness rate of up to 60-80%. Eltrombopag was well tolerated and had a good safety profile. It is recommended for patients with splenectomized ITP who are refractory to other treatments (e.g., corticosteroids, immunoglobulins). It can also be considered as a second-line treatment for adult non-splenectomy patients who refuse surgery or have contraindications for surgery.

The recommended starting dose of eltrombopag is 50 mg once daily. The starting dose should be reduced to 25 mg in patients of East Asian ancestry. After starting eltrombopag, the dose may be increased if no significant increase in platelet count is observed after 2-3 weeks of treatment. After a stable platelet count is achieved at a specific dose, the dose should be further adjusted to the lowest dose sufficient to maintain the platelet count around 50 × 109/L with minimal bleeding symptoms. In the EXTEND study, 13 of 301 patients (4.5%) achieved long-term remission (median 50 weeks) without receiving ITP after discontinuing eltrombopag. The median time to diagnosis of ITP was 24 months, and the median duration of eltrombopag treatment was 237 days.

In most patients who responded, platelet counts began to increase after the first week of treatment and peaked during the second week. Therefore, eltrombopagcan be used to prepare patients with chronicITP for elective surgery. Patients can begin taking eltrombopag at home 2 weeks before scheduled surgery, thus avoiding the common practice of receiving an IVIG infusion before surgery.

Therefore, in some patients with chronicITP, the dose of eltrombopag may be tapered and eventually discontinued. If disease relapses, eltrombopag can be restarted at the previously effective dose. Based on data from repeated studies, such patients may still respond to eltrombopag.