Successful Reswitching of Thrombopoietin Receptor Agonists: Two Cases of Immune Thrombocytopenia and Severe Aplastic Anemia

We used thrombopoietin receptor agonists (TPO-RAs) to treat immune thrombocytopenia (ITP) and aplastic anemia (AA). Molecular structures and methods of action differ among TPO-RAs; therefore, switching to another may be beneficial if one fails. In elderly people, planning and attending outpatient visits may complicate weekly subcutaneous romiplostim delivery. In two cases, the patient was initially unresponsive to eltrombopag, so we switched to romiplostim and then switched back due to hospital visits, which resulted in stabilizing platelet counts. We suggest better management techniques for patients, as ITP and AA require long-term management, which becomes increasingly challenging with increasing patient age.