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Hamostaseologie
DOI: 10.1055/a-2250-9369
Review Article

Novel Perspectives on Thrombopoietin Receptor Agonists Applications

Christos Stafylidis
1   Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
,
Dimitra Vlachopoulou
1   Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
,
Stavroula Syriopoulou
1   Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
,
Sevastianos Chatzidavid
1   Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
,
Nora-Athina Viniou
1   Hematology Unit, First Department of Internal Medicine, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Abstract

Second-generation thrombopoietin receptor agonists (TPO-RAs), romiplostim, eltrombopag, and avatrombopag, have been proved to be significant stimulators of megakaryopoiesis and, in the last decade, they have been incorporated in the treatment options against refractory immune thrombocytopenia in children and adults that do not respond to conventional therapy. Additionally, given their beneficial impact on hematopoiesis, they have successfully been applied in cases of non-immune thrombocytopenia, such as aplastic anemia, HCV-related thrombocytopenia, chronic liver disease, and most recently acute radiation syndrome. During the past years, a wide variety of clinical studies have been performed, in regard to the use of TPO-RAs in various thrombocytopenic settings, such as malignant hematology and hematopoietic stem cell transplantation, hereditary thrombocytopenias, and chemotherapy-treated patients with solid organ tumors. Although data indicate that TPO-RAs may be an effective and safe option for managing disease- or treatment-related thrombocytopenia in these patients, further research is needed to determine their efficacy and safety in these settings. Furthermore, recent studies have highlighted novel properties of TPO-RAs that render them as potential treatment candidates for reducing tumor burden or fighting infections. Herein, we discuss the potential novel applications of TPO-RAs and focus on data regarding their efficacy and safety in these contexts.

Zusammenfassung

Zweitgeneration Thrombopoetin-Rezeptor-Agonisten (TRA), Romiplostim, Eltrombopag und Avatrombopag, wurden als bedeutende Stimulatoren der Megakaryopoese nachgewiesen und sind im letzten Jahrzehnt in den Behandlungsoptionen bei refraktärer Immunthrombozytopenie bei Kindern und Erwachsenen, die nicht auf konventionelle Therapie ansprechen, integriert worden. Zusätzlich zu ihrem positiven Einfluss auf die Hämatopoese wurden sie erfolgreich in Fällen von nicht-immunthrombozytopenen Erkrankungen eingesetzt, wie zum Beispiel aplastiche Anämie, HCV-bedingte Thrombozytopenie, chronische Lebererkrankungen und zuletzt dem akuten Strahlensyndrom. In den letzten Jahren wurde eine Vielzahl von klinischen Studien durchgeführt, die den Einsatz von TRA in verschiedenen thrombozytopenischen Situationen betrachten, wie in der malignen Hämatologie und der hämatopoetischen Stammzelltransplantation, bei erblichen Thrombozytopenien und bei Patienten mit soliden Organtumoren, die einer Chemotherapie unterzogen wurden. Obwohl Daten darauf hindeuten, dass TRA eine wirksame und sichere Option zur Behandlung von krankheits- oder therapiebedingter Thrombozytopenie bei diesen Patienten sein könnten, sind weitere Forschungen erforderlich, um ihre Wirksamkeit und Sicherheit in diesen Kontexten zu bestimmen. Darüber hinaus haben aktuelle Studien neuartige Eigenschaften von TRA hervorgehoben, die sie als potenzielle Behandlungskandidaten zur Reduzierung der Tumorlast oder Bekämpfung von Infektionen darstellen. Hierin diskutieren wir potenzielle neue Anwendungen von TRA, wobei wir uns auch auf Daten zu ihrer Wirksamkeit und Sicherheit in diesen Kontexten konzentrieren.

Keywords

eltrombopag - romiplostim - avatrombopag

Schlüsselwörter

eltrombopag - romiplostim - avatrombopag


Publication History

Received: 30 October 2023

Accepted: 18 January 2024

Article published online:
18 March 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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