Eltrombopag May Be Noninferior to Intravenous Immunoglobulin for Presurgery Platelet Count Boost

The following article features coverage from the 61st American Society of Hematology Annual Meeting and Exposition. Click here to read more of Hematology Advisor’s conference coverage.

Eltrombopag appears to be noninferior to intravenous immunoglobulin (IVIG) for raising platelet count targets before surgery among patients with immune thrombocytopenia (ITP), according to research presented at the 61st American Society of Hematology (ASH) Annual Meeting in Orlando, Florida.

Patients with ITP frequently need treatment to increase platelet counts prior to surgery. Although IVIG is often used for this purpose, eltrombopag, an oral thrombopoietin receptor agonist, is a possible alternative. For this randomized, multicenter study, researchers evaluated whether eltrombopag is noninferior to IVIG for improving platelet counts prior to major or minor surgery.

Between 2013 and 2019, 74 patients with ITP were enrolled and assigned to receive wither eltrombopag (38 patients) or IVIG (36 patients) prior to major or minor surgery (31 and 43 patients, respectively). All patients had a platelet count of less than 100 x 10⁹/L prior to major surgery or less than 50 x 10⁹/L prior to minor surgery; the study’s primary end point was reaching platelet count targets of 90 x 10⁹/L prior to major surgery or 45 x 10⁹/L prior to minor surgery.

Sixty-nine patients completed the study. According to the intention-to-treat analysis, 30 patients (78.9%) assigned to receive eltrombopag reached perioperative platelet count targets, compared with 22 patients (61.1%) assigned to receive IVIG (P for noninferiority =.005). A per-protocol analysis yielded similar results (P for superiority =.074), though eltrombopag was superior to IVIG only in the intention-to-treat analysis (P for superiority =.047).

Although global treatment satisfaction scores were higher in the eltrombopag group, 1 patient developed a pulmonary embolism 7 days after discontinuing eltrombopag (and 14 days after completing minor surgery). Two of the study’s 18 patients who underwent splenectomy developed thrombocytosis after surgery; both had been assigned to the eltrombopag group.

“Eltrombopag is noninferior and may be superior to IVIG for achieving target platelet counts perioperatively for patients with ITP,” the authors wrote. “Postoperative thromboprophylaxis should be considered with eltrombopag.”

Disclosures: Some authors have declared affiliations with the pharmaceutical industry. Please refer to the original study for a full list of disclosures.

Reference

1. Arnold DM, Heddle N, Cook R, et al. Perioperative eltrombopag or intravenous immune globulin for patients with immune thrombocytopenia: a multicenter randomized trial. Oral presentation at: 61st ASH Annual Meeting and Exposition; December 7-10, 2019; Orlando, FL. Abstract 896.