Agonisti trombopoetinskih receptora u lečenju primarne imunske trombocitopenije odraslih – naša iskustva
Sažetak
Uvod/Cilj. Lečenje primarne imunske trombocitopenije (ITP) se zahvaljujući agonistima trombopoetinskih receptora (TPO-RA), značajno izmenilo tokom prethodne decenije. Cilj rada je bio da se utvrdi efikasnost TPO-RA u lečenju bolesnika sa hroničnom ITP u Univerzitetskom kliničkom centru Srbije. Metode. U studiju je bilo uključeno 28 odraslih bolesnika sa ITP (10 muškog pola i 18 ženskog pola) lečenih primenom eltrombopaga i/ili romiplostima. Prikupljani su demografski podaci, trajanje ITP, prethodni terapijski modaliteti, komorbiditeti, prateća terapija (kako za komorbiditete tako i za ITP), indikacije za uvođenje TPO-RA, krvarenje pre i tokom primene TPO-RA, prosečne doze TPO-RA, neželjeni događaji i stopa terapijskog odgovora na TPO-RA. Indikacije za primenu TPO-RA bile su hronična refraktona ITP, kontraindikovana/neizvodljiva splenektomija i priprema za splenektomiju. Povoljan odgovor na lečenje je bio definisan kao stabilan broj trombocita ≥ 50 × 109/L. Rezultati. Ukupno 22 (78,57%) bolesnika lečena su eltrombopagom, a 14 (50,0%) bolesnika romiplostimom. Dobar terapijski odgovor (DTO) postignut je kod 81,8% bolesnika lečenih eltrombopagom i kod 71,4% bolesnika lečenih romiplostimom. Bolesnici kod kojih nije postignut DTO na eltrombopag (4 bolesnika) i oni koji su izgubili DTO na eltrombopag (4 bolesnika) prevedeni su na romiplostim. Kod njih 6/8 postignut je DTO. U vreme uvođenja TPO-RA, 46,4% bolesnika je koristilo prateću terapiju za ITP, koja je kod svih ukinuta po postizanju DTO. U toku primene TPO-RA zabeleženi su sledeći neželjeni događaji: transaminitis i tranzitorni ishemijski atak kod po jednog bolesnika lečenog eltrombopagom i plućna embolija kod jednog bolesnika lečenog romiplostimom. Zaključak. S obzirom na to da je većina bolesnika tokom lečenja postigla stabilnu remisiju, bez epizoda krvarenja, naši rezultati su pokazali da su TPO-RA efikasni i bezbedni u lečenju odraslih bolesnika sa ITP.
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