Therapeutic Management of Immune Thrombocytopenia Case 1 - Episode 7
James B. Bussel, MD:Time of response to a TPO-RA is a little bit of a complicated question. With eltrombopag, you typically start, as this patient did, with 50 mg daily. And chances are if the patient is going to respond, they’ll respond within about 2 weeks. If not, they can go to the maximum dose, which is 75 mg daily, and then if they’re going to respond, they would respond within another 2 weeks or perhaps 3 at the most. This is my opinion. I’m not sure there are perfect data on time to response in groups. In groups of patients, when you look at time to response, it’s within 2 weeks. But if you’re asking how long will it take all patients to respond, it might take up to 4 to 5 weeks for those who are going to respond to respond.
With romiplostim, it depends on how you dose. I believe the package insert still says to start with 1 mcg/kg and then go to 2 mcg/kg and then to 3 mcg/kg and then to 4 mcg/kg. So, it could take you 9 weeks or 10 weeks, depending on how you count it, to get to 10 mcg/kg, which is the maximum dose. Most people with experience in practice don’t follow the package insert and start at 3 mcg/kg and then maybe go to 5 mcg/kg and 7 mcg/kg and 10 mcg/kg. So, again, the platelet count should go up in about the same timeframe, let’s say 2 to 5 weeks, if it’s going to go up. Responders receiving a dose to which they’ll respond of either eltrombopag or romiplostim will probably have their count begin to rise at day 4 or 5 and will be obviously higher than baseline by day 7.
Transcript edited for clarity.
Case: A 48-year-old woman presenting with unusual bruising