Switching patients with immune thrombocytopenia (ITP) to avatrombopag from other thrombopoietin receptor agonists: The real-world experience of the Spanish ITP Group (GEPTI).

Avatrombopag is a thrombopoietin receptor agonist (TPO-RA) suitable for patient-centred care. Avatrombopag achieved lasting platelet count (PC) increases in small series of immune thrombocytopenia (ITP) patients in whom other TPO-RAs had failed. We recruited 208 patients with ITP who switched from eltrombopag or romiplostim to avatrombopag due to ineffectiveness (115 [55.3%]), convenience (66 [31.7%]) or treatment-emergent adverse events (TEAEs) (27 [13.0%]). Patients were followed up for 63.9 (31.1-100.4) weeks (median [interquartile range]). Ninety-two per cent of switchers due to ineffectiveness who had baseline PC <50 × 109/L responded to avatrombopag (PC ≥50 × 109/L with doubling of baseline values). Response was maintained in 81.2% of patients after 56.4 (24.6-90.2) weeks. Ninety-two per cent of switchers due to convenience or TEAEs maintained a long-term response. Fifty-one per cent of switchers due to TPO-RA failure who used concomitant medications discontinued these while on avatrombopag. In switchers due to convenience or TEAEs, the maintenance dose decreased from 140 (140-140) to 80 (60-140) mg/week. Fourteen patients (6.7%) discontinued avatrombopag due to TEAEs. The thromboembolism rate was 3.8%. No new safety concerns arose. In this large real-world cohort, switching from eltrombopag or romiplostim to avatrombopag safely induced durable PC recovery.