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Granulomatous Diseases
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Albert Alhatem, Robert A. Schwartz, Muriel W. Lambert, W. Clark Lambert
Depending on the cause, other useful treatments may include corticosteroids, intravenous immunoglobulin, and other drug therapies to achieve platelet count ≥50,000/mm3: romiplostim (1 mcg/kg subcutaneous injection once weekly), eltrombopag (50 mg orally once daily) or rituximab (IV infusion: 375 mg/m2 once weekly for 4 doses). Splenectomy is reserved in some particular cases and causes if medications are not effective. In emergencies, when purpura causes extreme bleeding, transfusions of platelet concentrates, corticosteroids, and immunoglobulin may be used.
Precision medicine in myelodysplastic syndromes
Published in Debmalya Barh, Precision Medicine in Cancers and Non-Communicable Diseases, 2018
Thrombocytopenia is commonly seen in MDS patients, and bleeding complications are a major cause of morbidity and mortality. Thrombocytopenia is an independent factor for decreased survival and has been incorporated in newer prognostic scoring systems. The mechanisms of thrombocytopenia are multifactorial and involve a differentiation block of megakaryocytic progenitor cells, leading to dysplastic, hypolobated, and microscopic appearing megakaryocytes or increased apoptosis of megakaryocytes and their precursors. Dysregulated thrombopoietin (TPO) signaling and increased platelet destruction through immune or nonimmune mechanisms are frequently observed in MDS. The clinical management of patients with low platelet counts remains challenging and approved chemotherapeutic agents, such as lenalidomide and azacytidine, can also lead to a transient worsening of thrombocytopenia. Platelet transfusion was the only supportive treatment option for clinically significant thrombocytopenia. The TPO receptor agonists romiplostim and eltrombopag have shown clinical activity in clinical trials in MDS (Li et al., 2016; Oliva et al., 2017).
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Published in Caroline Ashley, Aileen Dunleavy, John Cunningham, The Renal Drug Handbook, 2018
Caroline Ashley, Aileen Dunleavy, John Cunningham
There is a case report using romiplostim in a haemodialysis patient at a dose of 2.5–5 mcg/kg with good effect with no side effects. (Al-Jafar H, Giagounidis A, El-Rashaid K, et al. Use of romiplostim in a hemodialysis patient with primary immune thrombocytopenia. Ann Pharmacother. 2012; 46(11): e31.)
Emerging data on thrombopoietin receptor agonists for management of chemotherapy-induced thrombocytopenia
Published in Expert Review of Hematology, 2023
Andrew B. Song, Hanny Al-Samkari
Several factors may impact patient preference and adherence to different TPO-RAs [55,56]. Romiplostim is administered as a subcutaneous injection which may be less favorable for patients compared to the straight administration of an oral medication but may be favorable for patients experiencing ongoing nausea, vomiting, aspiration risk, or malabsorption. Eltrombopag requires a 4 to 6-hour period of fasting around administration as it is poorly absorbed when taken with high-fat and high-calcium meals due to drug chelation of polyvalent cations. Eltrombopag and hetrombopag both require liver chemistry monitoring due to risk of hepatotoxicity. The logistical simplicity of dose adjustments is also different between TPO-RAs, and the relative potency is not defined in CIT; as in other diseases, patients not responding to one agent may respond to another [57,58]. Once sufficient efficacy and safety data are reported for the oral TPO-RAs to consider routine use for treatment of CIT, real world observational data will be needed to assess patient preference and adherence.
Alternatives for managing patients with newly diagnosed immune thrombocytopenia: a narrative review
Published in Expert Review of Hematology, 2022
David Gómez-Almaguer, Edgar A. Rojas-Guerrero, Andrés Gómez-De León, Perla R. Colunga-Pedraza, José C. Jaime-Pérez
A single-arm study evaluated the use of romiplostim in patients less than six months from diagnosis. The drug was given to 75 adults with newly diagnosed ITP to a target platelet count of 50–200 x 109/L. After 12 months, a high response rate (>90%) was observed. Patients with a platelet count above 50 x 109/L gradually tapered and discontinued romiplostim with long-term disease remission in 24 patients (32%) [61]. It is important to note that romiplostim was added to other conventional first-line treatments or in patients who failed to achieve a response to conventional first-line treatments, not as first-line therapy. Furthermore, a post hoc subgroup analysis from this phase 2 study stratified by duration of ITP diagnosis, newly diagnosed (<3 months post-diagnosis) and persistent (≥3-≤12 months), concluded similar efficacy when used in patients with primary ITP, irrespective of whether patients had newly diagnosed or persistent disease [62].
Experts’ review: the emerging roles of romiplostim in immune thrombocytopenia (ITP)
Published in Expert Opinion on Biological Therapy, 2021
Frederick Chen, Vickie McDonald, Adrian Newland
The weekly dosing of romiplostim as a subcutaneous injection is user-friendly and convenient, and does not require dietary and time restrictions associated with daily oral TPO-RA, provided that the patient can self-administer the drug. An important aspect of improving QOL, is for patients to spend less time in the hospital setting and be able to take control and administer their medication independently. In Europe romiplostim is licensed for self-administration once a stable platelet count >50x109/L is attained, but in other jurisdictions, romiplostim can only be administered by health professionals, in part due to concern regarding safety and efficacy. The recent review of the data from five clinical trials confirmed no difference in efficacy, safety and complications between healthcare professional-administered and patient-self-administered romiplostim, concluding that self-administration does not adversely affect safety [30,116].