Skip to main content

Advertisement

Log in

Oral eltrombopag for up to three years is safe and well-tolerated in Japanese patients with previously treated chronic immune thrombocytopenia: an open-label, extension study

  • Original Article
  • Published:
International Journal of Hematology Aims and scope Submit manuscript

Abstract

Eltrombopag is an oral, nonpeptide, thrombopoietin receptor agonist approved for treatment of chronic immune thrombocytopenia (ITP). The safety, tolerability, and efficacy of eltrombopag for up to 3 years were evaluated in 19 Japanese patients with chronic ITP who had completed a prior 6-month study. Patients received eltrombopag once daily at the last dosage received in the prior study (12.5, 25, or 50 mg). Dose adjustments and treatment interruptions were permitted to maintain platelet counts of 50,000–200,000/μL. Primary evaluations were safety and tolerability of long-term eltrombopag treatment. The median duration of exposure was 27.5 months (range, 9.9–32.3). Adverse events were similar to those reported with short-term use of eltrombopag, and none led to treatment discontinuation. Nine serious adverse events were reported. Median platelet counts began to increase after 1 week of treatment and remained above 50,000/μL for most assessments. Bleeding episodes decreased from 63 % at baseline to 21 % after 2 weeks of treatment and remained below baseline for all assessments. Of 15 patients receiving concomitant baseline ITP medications, 10 permanently discontinued or achieved a sustained reduction of at least one treatment without requiring rescue treatment. Long-term treatment with eltrombopag was safe, well tolerated, and effective in Japanese patients with chronic ITP.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009;113:2386–93.

    Article  PubMed  CAS  Google Scholar 

  2. Provan D, Stasi R, Newland AC, Blanchette VS, Bolton-Maggs P, Bussel JB, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010;115:168–86.

    Article  PubMed  CAS  Google Scholar 

  3. Kurata Y, Fujimura K, Kuwana M, Tomiyama Y, Murata M. Epidemiology of primary immune thrombocytopenia in children and adults in Japan: a population-based study and literature review. Int J Hematol. 2011;93:329–35.

    Article  PubMed  Google Scholar 

  4. Butros LJ, Bussel JB. Intracranial hemorrhage in immune thrombocytopenic purpura: a retrospective analysis. J Pediatr Hematol Oncol. 2003;25:660–4.

    Article  PubMed  Google Scholar 

  5. Cohen YC, Djulbegovic B, Shamai-Lubovitz O, Mozes B. The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistent low platelet counts. Arch Intern Med. 2000;160:1630–8.

    Article  PubMed  CAS  Google Scholar 

  6. McMillan R, Durette C. Long-term outcomes in adults with chronic ITP after splenectomy failure. Blood. 2004;104:956–60.

    Article  PubMed  CAS  Google Scholar 

  7. Stasi R, Evangelista ML, Stipa E, Buccisano F, Venditti A, Amadori S. Idiopathic thrombocytopenic purpura: current concepts in pathophysiology and management. Thromb Haemost. 2008;99:4–13.

    PubMed  CAS  Google Scholar 

  8. Vianelli N, Galli M, de Vivo A, Intermesoli T, Giannini B, Mazzucconi MG, et al. Efficacy and safety of splenectomy in immune thrombocytopenic purpura: long-term results of 402 cases. Haematologica. 2005;90:72–7.

    PubMed  Google Scholar 

  9. Fujimura K, Miyakawa Y, Kurata Y, Kuwana M, Tomiyama Y, Murata M. Reference guide for management of adult idiopathic thrombocytopenic purpura (ITP) 2012 version [Japanese]. Rinsho Ketsueki. 2012;53:433–42.

    PubMed  Google Scholar 

  10. Garnock-Jones KP, Keam SJ. Eltrombopag. Drugs. 2009;69:567–76.

    Article  PubMed  CAS  Google Scholar 

  11. Promacta® (eltrombopag) prescribing information. Research Triangle Park, NC: GlaxoSmithKline, November 2012. http://www.gsksource.com/gskprm/en/US/adirect/gskprm?cmd=ProductDetailPage&product_id=1353688574915&featureKey=603802&tab=tab1&footer=yes&pTab=one#nlmhighlights. Accessed February 28, 2013.

  12. Revolade® (eltrombopag). Summary of product characteristics. Cork, Ireland: GlaxoSmithKline, 2011. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/001110/WC500089964.pdf. Accessed February 28, 2013.

  13. Shida Y, Takahashi N, Nohda S, Hirama T. Pharmacokinetics and pharmacodynamics of eltrombopag in healthy Japanese males. Jpn J Clin Pharmacol Ther. 2011;42:11–20.

    Article  CAS  Google Scholar 

  14. Gibiansky E, Zhang J, Williams D, Wang Z, Ouellet D. Population pharmacokinetics of eltrombopag in healthy subjects and patients with chronic idiopathic thrombocytopenic purpura. J Clin Pharmacol. 2011;51:842–56.

    Article  PubMed  CAS  Google Scholar 

  15. Tomiyama Y, Miyakawa Y, Okamato S, Katsutani S, Kimura A, Okoshi Y, et al. A lower starting dose of eltrombopag is efficacious in Japanese patients with previously treated chronic immune thrombocytopenia (ITP). J Thromb Haemost. 2012;10:799–806.

    Article  PubMed  CAS  Google Scholar 

  16. Thiele J, Kvasnicka HM, Facchetti F, et al. European consensus on grading bone marrow fibrosis and assessment of cellularity. Haematologica. 2005;90:1128–32.

    PubMed  Google Scholar 

  17. Bussel JB, Cheng G, Saleh MN, Psaila B, Kovaleva L, Meddeb B, et al. Eltrombopag for the treatment of chronic idiopathic thrombocytopenic purpura. N Engl J Med. 2007;357:2237–47.

    Article  PubMed  CAS  Google Scholar 

  18. Bussel JB, Provan D, Shamsi T, Cheng G, Psaila B, Kovaleva L, et al. Effect of eltrombopag on platelet counts and bleeding during treatment of chronic idiopathic thrombocytopenic purpura: a randomised, double-blind, placebo-controlled trial. Lancet. 2009;373:641–8.

    Article  PubMed  CAS  Google Scholar 

  19. Cheng G, Saleh MN, Marcher C, Vasey S, Mayer B, Aivado M, et al. Eltrombopag for management of chronic immune thrombocytopenia (RAISE): a 6-month, randomised, phase 3 study. Lancet. 2011;377:393–402.

    Article  PubMed  CAS  Google Scholar 

  20. Saleh MN, Cheng G, Bussel JB, Burgess P, Marcello L, Bailey CK, Brainsky A. Safety and efficacy of extended treatment with eltrombopag in adults with chronic immune thrombocytopenia (ITP) from June 2006 to February 2011. Blood; 2011. p. 118: Abstract 3296.

  21. Mufti G, Bagg A, Hasserjian R, Bain B, Kuter D, Dreiling L, Nichol J. Bone marrow reticulin in patients with immune thrombocytopenic purpura. Blood; 2006. p. 108: Abstract 3982.

  22. Brynes RK, Orazi A, Verma S, Brainsky A, Bailey CK, Bakshi K. Evaluation of bone marrow reticulin in patients with chronic immune thrombocytopenic purpura (ITP) treated with eltrombopag–data from the EXTEND study. Blood; 2011. p. 118: Abstract 528.

  23. Matzdorff A, Arnold G. Treatment of chronic immune thrombocytopenic purpura: the patients’ perspective. Eur J Haematol. 2007;78:381–8.

    Article  PubMed  Google Scholar 

  24. Portielje JE, Westendorp RG, Kluin-Nelemans HC, Brand A. Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Blood. 2001;97:2549–54.

    Article  PubMed  CAS  Google Scholar 

  25. Bussel JB, Rodeghiero F, Lyons RM, Firstenberg B, Joseph J, Kessler CM, et al. Sustained hemostatic platelet counts in adults with immune thrombocytopenia (ITP) following cessation of treatment with the TPO receptor agonist romiplostim: report of 9 cases. Blood; 2011. p. 118: Abstract 3281.

  26. Yu J, Heck S, Patel V, Levan J, Yu Y, Bussel JB, Yazdanbakhsh K. Defective circulating CD25 regulatory T cells in patients with chronic immune thrombocytopenic purpura. Blood. 2008;112:1325–8.

    Article  PubMed  CAS  Google Scholar 

  27. Bao W, Bussel JB, Heck S, He W, Karpoff M, Boulad N, Yazdanbakhsh K. Improved regulatory T-cell activity in patients with chronic immune thrombocytopenia treated with thrombopoietic agents. Blood. 2010;116:4639–45.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Funding for this study (NCT00828750) was provided by GlaxoSmithKline (GSK). All listed authors meet the criteria for authorship set forth by the International Committee for Medical Journal Editors. The authors wish to acknowledge the following individuals for their contributions and critical review during the development of this manuscript on behalf of GSK: Ted Everson, PhD, and Meher Dustoor, PhD, of AOI Communications, L.P., for medical writing and editorial assistance, and Kimberly Marino and Michael Arning of GSK for critical review.

Conflict of interest

S. Katsutani has no conflict relevant to the subject matter or materials included in this manuscript. Y. Tomiyama has received honoraria from GlaxoSmithKline (GSK) and Kyowa Hakko Kirin Co., Ltd. A. Kimura has received honoraria from GSK. Y. Miyakawa has received honoraria from GSK, Kyowa Hakko Kirin Co., Ltd., and Eisai Co., Ltd., and royalty from Ono Pharmaceuticals Co., Ltd. Y. Ikeda has acted as a consultant to Sanofi-Aventis and AstraZeneca, has received research funding from Sanofi-Aventis, and has received honoraria from Sanofi-Aventis, GSK, and Kyowa Hakko Kirin Co., Ltd. T. Hattori and K. Katsura are employees of GSK. S. Okamoto, Y. Okoshi, H. Ninomiya, H. Kosugi, and K. Ishii have no conflicts of interest relevant to the subject matter or materials included in this manuscript. Y. Kanakura has received grants from GSK and Kyowa Hakko Kirin Co., Ltd., through the Osaka University.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Shinya Katsutani.

About this article

Cite this article

Katsutani, S., Tomiyama, Y., Kimura, A. et al. Oral eltrombopag for up to three years is safe and well-tolerated in Japanese patients with previously treated chronic immune thrombocytopenia: an open-label, extension study. Int J Hematol 98, 323–330 (2013). https://doi.org/10.1007/s12185-013-1401-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12185-013-1401-1

Keywords

Navigation