DP065 | EFFICACY AND SAFETY OF TPO-RA IN IDIOPATHIC THROMBOCYTOPENIC PURPURA PATIENTS: A RETROSPECTIVE MONOCENTRIC REAL-LIFE STUDY

Background: The thrombopoietin receptor agonists (TPOra) represent the second line in the management of idiopathic thrombocytopenic purpura (ITP). The mechanism of action consists in acting on thrombopoietin receptor and stimulating platelet (plt) production. The efficacy of these drugs has been demonstrated by registration studies and clinical practice. Moreover, switching to another TPOra resulted in a plt response in at least 50% of patients (pts). Finally, several analyses have examined the Sustained Remission Off-Treatment (SROT), which is achieved in about 30% of treated pts. Aims: To evaluate the efficacy and safety of TPOra treatment in a real-life setting of ITP pts followed in Hematology Department of Florence (AOU Careggi), including pts switching to another TPOra. Materials and methods: We retrospectively collected data of 100 ITP pts treated with one or more TPOra between January 2014 and December 2024 in the center. The median age was 62 years (18-89) with a prevalence of women (62%). First, we evaluated all pts treated with a first TPOra (67 eltrombopag, 33 romiplostim); then we evaluated 46 pts(46%) who had switched to a second TPOra (8 eltrombopag,27 romiplostim,11 avatrombopag). The response (R) was estimated at the following timepoints (tp): 1 week,1 month, 3 months, 6 months. Results: A response to first TPOra has been obtained in 87 pts(87%), with no statistically difference between Group 1 (Eltrombopag) and Group 2 (Romiplostim). Table 1 shows the characteristics of the entire cohort. R was mostly seen within the 1 month, with no statistically difference between the two groups. 36 pts (36%) discontinued the drugs due to loss of R. 11 pts (11%) achieved the SROT, which was maintained for 30.3 months (10-79). 46 pts (46%) switched to a second TPOra. Of this cohort, 41 pts (89.1%) responded to treatment with a median time of 8 days (6-16). 12 pts (26%) discontinued drugs due to loss of R. The SROT to a second TPOra was achieved in 3 pts(6%). Adverse events (AE) and severe AE were reported in less than 35% of pts, in particular occured 3(3%) thrombotic events (1 thromboembolism,1 TIA,1 heart attack). Conclusions: According to literature, our study confirmed the efficacy and safety of TPOra. The observed response to switching from a TPOra to another underscores the importance of these agents in the management of ITP. Finally, the potential for therapy discontinuation may enhance pts adherence to treatment, thereby improving overall disease management.