AGONISTI TROMBOPOETINSKIH RECEPTORA U LEČENJU PRIMARNE IMUNSKE TROMBOCITOPENIJE: NAŠE ISKUSTVO
Sažetak
Primarna imunska trombocitopenija (ITP) jeste stečena autoimuna bolest koja se odlikuje izolovanom trombocitopenijom Tr < 100 x 109/L i odsustvom svih stanja i bolesti koje mogu dovesti do trombocitopenije. Prva terapijska linija podrazumeva primenu kortikosteroida, intravenskih aplikovanih imunoglobulina ili anti-D imunoglobulina. Druga terapijska linija obuhvata splenektomiju, imunosupresivne lekove i agoniste trombopoetinskih receptora (TPO-RA). Cilj ove studije bio je da prikaže rezultate lečenja bolesnika sa ITP-om koji su na Klinici za hematologiju Univerzitetskog kliničkog centra u Nišu lečeni agonistima trombopoetinskih receptora (eltrombopagom). U periodu od marta 2018. do decembra 2023. godine primenom eltrombopaga lečeno je šest bolesnika sa ITP-om kod kojih je došlo do izostanka odgovora na prethodne linije terapije ili do ispoljavanja neželjenih efekata. Indikacija za uvođenje eltrombopaga bio je hronični ITP. Vreme od postavljanja dijagnoze ITP-a do otpočinjanja terapije TPO-RA iznosilo je u proseku 71,5 meseci. Analiza prosečnog broja trombocita po uvođenju TPO-RA pokazala je trend porasta broja trombocita, bez neželjenih efekata. Agonisti TPO-RA ne pokazuju imunosupresiju, dovode do porasta broja trombocita, prestanka krvarenja i poboljšanja kvaliteta života. Upravo zato, agonisti TPO-RA predstavljaju neophodne lekove za lečenje ITP-a posle neuspeha prve i druge terapijske linije.
Reference
Arnall J, Di Sogra K, Downing L, Elmes JB, Tran Th, Moore DC. Comparative Utilization and Efficacy of Thrombopoietin Receptor Agonists in Relapsed/refractory Immune Thrombocytopenia. An J Ther 2021; 28(5):525-30. [CrossRef] [PubMed]
Boyers D, Jia X, Crowther M, Jenkinson D, Fraser C, Mowalt G. Eltrombopag for the treatment od chronic idiopathic (immune) thrombocytopenic purpura (ITP). Health Technol Assess 2011; 15(1): 23-32. [CrossRef] [PubMed]
British Committee for Standards in Haematology General Haematology Task Force. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and pregnancy. Br J Hematol 2003; 120: 574-96. [CrossRef] [PubMed]
Bussel JB, Saleh MN, Vasey SY, Mayer B, Arning M, Stone NL. Repeated short-term use ef eltrombopag in patients with chronic immune thrombocytopenia (ITP). Br J Haematolog 2013; 160: 538-46. [CrossRef] [PubMed]
Cheng G, Saleh M, Marchen C, Vasey S, Mayer B, Aivado M, et al. Eltrombopag for management of chronic immune thrombocytopenia (RAISE): a 6-month, randomized, phase 3 study. Lancet 2011; 377: 399-402. [CrossRef] [PubMed]
Cheng G. Eltrombopag for the treatment of immune thrombocytopenia. Expert Rev Hematol 2011; 4(3): 261-9. [CrossRef]
Garnock-Jones KP. Eltrombopag: a review of its use in treatment-refractory chronic primary immune thrombocytopenia. Drugs 2011; 71(10):1333-53. [CrossRef] [PubMed]
Gomez D. Eltrombopag-based combination treatment for immune thrombocytopenia. Ther Adv Hematol 2018; 9(10):309-17. [CrossRef] [PubMed]
Gonzales -Porras JR, Bastida JM. Eltrombopag in immune thrombocytopenia:efficacy review and update on drug safety. Ther Adv Saf 2018; 9(6): 263-85. [CrossRef] [PubMed]
Hamed EM, Meabed MH, Ibrahim ARN, El Demerdash DM, Elgendy MO, Saeed H, et al. Clinical Care Team,s Guide for Awareness on Risk Assessment of Eltrombopag Complicating Acute Kidney Injury in Relapsed Immune Thrombocytopenic Patients: A Case Report. Medicina 2023; 59(9): 1645-57. [CrossRef] [PubMed]
Kim DS. Recent advances in treatments of adult immune thrombocytopenia. Blood Res 2022; 57(S1): 112-9. [CrossRef] [PubMed]
Kuter D. The biology of thrombopoietin and thrombopoietin receptor agonists. Int J Hematol 2013; 98(1): 10.23. [CrossRef] [PubMed]
Mitchell WB, Bussel JH. Thrombopietin receptor agonists: a critical review. Semin Hematol 2015; 52: 46-52. [CrossRef] [PubMed]
Neunert C, Lim W, Crowther M, Cohen A, Solberg Jr L, Crowther MA. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood 2011; 117: 4190-207. [CrossRef] [PubMed]
Newland A. The diagnosis and management of chronic immune thrombocytopenia in adults. Hematology education; the educational program for the annual congress of the Europan Haematology association. London. United Kingdom June 9-12, 2011; 5: 184-90.
Provan D, Stasi R, Newland AC, Bianchette VS, Bolton-Meggs P, Bussel JB, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2010; 115: 168-86. [CrossRef] [PubMed]
Rodeghiero F, Stasi R, Gemsheimer T, Michel M, Provan D,Amold DM, et al. Standardization of terminology, definitions and outcome criteria in immune group. Blood 2009; 113: 2386-93. [CrossRef] [PubMed]
Wong RSM, Yavasoglu I, Yassin M, Tarkun P, Yoon SS, Wei X, et al. Eltrombopag in patients with chronic immune thrombocytopenia in Asia-Pacific, the Middle East and Turkey: final analysis of CITE. Blood 2023; 17(7):4773-81. [CrossRef] [PubMed]
Zhang Y, JN. Kolesar JM. Eltrombopag: an oral thrombopoietin receptor agonist for the treatment of idiopathic thrombocytopenic purpura. Clin Ther 2011; 33(11): 1560-76. [CrossRef] [PubMed]
