There are currently three thrombopoietin receptor agonists (TPO-RAs) approved in Europe for treating patients with immune thrombocytopenia (ITP): romiplostim (Nplate®), eltrombopag (Revolade®), and avatrombopag (Doptelet®). However, comparative clinical data between these TPO-RAs are limited. Therefore, the purpose of this study was to perform a literature review and seek expert opinion on the relevance and strength of the evidence concerning the use of TPO-RAs in adults with ITP. A systematic search was conducted in PubMed and Embase within the last 10 years and until June 20, 2022. A total of 478 unique articles were retrieved and reviewed for relevance. The expert consensus panel comprised ITP senior hematologists from eight countries across Central Europe. The modified Delphi method, consisting of two survey rounds, a teleconference and email correspondence, was used to reach consensus. Forty articles met the relevancy criteria and are included as supporting evidence, including five meta-analyses analyzing all three European-licensed TPO-RAs and comprising a total of 31 unique randomized controlled trials (RCTs). Consensus was reached on seven statements for the second-line use of TPO-RAs in the management of adult ITP patients. In addition, the expert panel discussed TPO-RA treatment in chronic ITP patients with mild/moderate COVID-19 and ITP patients in the first-line setting but failed to reach consensus. This work will facilitate informed decision-making for healthcare providers treating adult ITP patients with TPO-RAs. However, further studies are needed on the use of TPO-RAs in the first-line setting and specific patient populations.

3rd Department of Internal Medicine Semmelweis University Budapest Hungary

Department of Hematology and Transfusion Medicine National Hemophilia Center Faculty of Medicine of Comenius University and University Hospital Bratislava Bratislava Slovakia

Department of Hematology Blood Neoplasms and Bone Marrow Transplantation Wroclaw Medical University Wroclaw Poland

Department of Internal Medicine Victor Babes University of Medicine and Pharmacy HematologyTimisoara Romania

Department of Standardization of Treatment Methods National Research Center for Hematology Russian Federation Moscow Russia

Division of Hematology Department of Internal Medicine University Hospital Center Zagreb University of Zagreb School of Medicine Kispaticeva 12 10 000 Zagreb Croatia

Faculty Hospital Brno Department of Internal Medicine Hematology and Oncology Masaryk University Brno Czech Republic

Specialized Hospital for Active Treatment of Hematological Diseases Sofia Bulgaria

Zobrazit více v PubMed

Semple JW, Provan D, Garvey MB, Freedman J (2010) Recent progress in understanding the pathogenesis of immune thrombocytopenia. Curr Opin Hematol 17(6):590–595. 10.1097/moh.0b013e32833eaef3 10.1097/moh.0b013e32833eaef3 PubMed DOI

Provan D, Semple JW (2022) Recent advances in the mechanisms and treatment of immune thrombocytopenia. eBioMedicine 76:103820. 10.1016/j.ebiom.2022.103820 PubMed PMC

Cooper N, Ghanima W (2019) Immune thrombocytopenia. N Engl J Med 381(10):945–955. 10.1056/NEJMcp1810479 10.1056/NEJMcp1810479 PubMed DOI

Terrell DR, Beebe LA, Vesely SK, Neas BR, Segal JB, George JN (2010) The incidence of immune thrombocytopenic purpura in children and adults: a critical review of published reports. Am J Hematol 85(3):174–180. 10.1002/ajh.21616 10.1002/ajh.21616 PubMed DOI

Sobas M, Podolak-Dawidziak M, Lewandowski K, Bator M, Wróbel T (2021) Primary immune thrombocytopenia and essential thrombocythemia: so different and yet somehow similar-cases series and a review of the literature. Int J Mol Sci 22(20):10918. 10.3390/ijms222010918 10.3390/ijms222010918 PubMed DOI PMC

Doobaree IU, Conway K, Miah H, Miah A, Makris M, Hill Q, Cooper N, Bradbury C, Newland A, Provan D, McDonald V, registry UaI (2022) Incidence of adult primary immune thrombocytopenia in England—an update. Eur J Haemat 109(3):238–249. 10.1111/ejh.13803 10.1111/ejh.13803 PubMed DOI

Lambert MP, Gernsheimer TB (2017) Clinical updates in adult immune thrombocytopenia. Blood 129(21):2829–2835. 10.1182/blood-2017-03-754119 10.1182/blood-2017-03-754119 PubMed DOI PMC

Cines DB, Liebman H, Stasi R (2009) Pathobiology of secondary immune thrombocytopenia. Semin Hematol 46(1 Suppl 2):S2–S14. 10.1053/j.seminhematol.2008.12.005 10.1053/j.seminhematol.2008.12.005 PubMed DOI PMC

Ballem PJ, Segal GM, Stratton JR, Gernsheimer T, Adamson JW, Slichter SJ (1987) Mechanisms of thrombocytopenia in chronic autoimmune thrombocytopenic purpura. Evidence of both impaired platelet production and increased platelet clearance. J Clin Invest 80(1):33–40. 10.1172/jci113060 10.1172/jci113060 PubMed DOI PMC

Harrington WJ, Sprague CC, Minnich V, Moore CV, Aulvin RC, Dubach R (1953) Immunologic mechanisms in idiopathic and neonatal thrombocytopenic purpura. Ann Intern Med 38(3):433–469. 10.7326/0003-4819-38-3-433 10.7326/0003-4819-38-3-433 PubMed DOI

Samson M, Fraser W, Lebowitz D (2019) Treatments for primary immune thrombocytopenia: a review. Cureus 11(10):e5849–e5849. 10.7759/cureus.5849 10.7759/cureus.5849 PubMed DOI PMC

Provan D, Arnold DM, Bussel JB, Chong BH, Cooper N, Gernsheimer T, Ghanima W, Godeau B, González-López TJ, Grainger J, Hou M, Kruse C, McDonald V, Michel M, Newland AC, Pavord S, Rodeghiero F, Scully M, Tomiyama Y, Wong RS, Zaja F, Kuter DJ (2019) Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv 3(22):3780–3817. 10.1182/bloodadvances.2019000812 10.1182/bloodadvances.2019000812 PubMed DOI PMC

Neunert C, Terrell DR, Arnold DM, Buchanan G, Cines DB, Cooper N, Cuker A, Despotovic JM, George JN, Grace RF, Kühne T, Kuter DJ, Lim W, McCrae KR, Pruitt B, Shimanek H, Vesely SK (2019) American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv 3(23):3829–3866. 10.1182/bloodadvances.2019000966 10.1182/bloodadvances.2019000966 PubMed DOI PMC

Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, Bussel JB, Cines DB, Chong BH, Cooper N, Godeau B, Lechner K, Mazzucconi MG, McMillan R, Sanz MA, Imbach P, Blanchette V, Kühne T, Ruggeri M, George JN (2009) Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 113(11):2386–2393. 10.1182/blood-2008-07-162503 10.1182/blood-2008-07-162503 PubMed DOI

Neunert CE (2017) Management of newly diagnosed immune thrombocytopenia: can we change outcomes? Hematology Am Soc Hematol Educ Program 2017(1):400–405. 10.1182/asheducation-2017.1.400 10.1182/asheducation-2017.1.400 PubMed DOI PMC

Moulis G, Germain J, Comont T, Brun N, Dingremont C, Castel B, Arista S, Sailler L, Lapeyre-Mestre M, Beyne-Rauzy O, Godeau B, Adoue D, Group TCI (2017) Newly diagnosed immune thrombocytopenia adults: clinical epidemiology, exposure to treatments, and evolution. Results of the CARMEN multicenter prospective cohort. Am J Hematol 92(6):493–500. 10.1002/ajh.24702 10.1002/ajh.24702 PubMed DOI

European Medicines Agency (EMA) Nplate - product information. https://www.ema.europa.eu/en/documents/product-information/nplate-epar-product-information_en.pdf. Accessed 30th May 2022

European Medicines Agency (EMA) Revolade - product information. https://www.ema.europa.eu/en/documents/product-information/revolade-epar-product-information_en.pdf. Accessed 30th May 2022

European Medicines Agency (EMA) Doptolet - product information. https://www.ema.europa.eu/en/documents/product-information/doptelet-epar-product-information_en.pdf. Accessed 30th May 2022

Zhang J, Liang Y, Ai Y, Li X, Xie J, Li Y, Zheng W, He R (2018) Eltrombopag versus romiplostim in treatment of adult patients with immune thrombocytopenia: a systematic review incorporating an indirect-comparison meta-analysis. PLoS One 13(6):e0198504. 10.1371/journal.pone.0198504 10.1371/journal.pone.0198504 PubMed DOI PMC

Cuker A, Despotovic JM, Grace RF, Kruse C, Lambert MP, Liebman HA, Lyons RM, McCrae KR, Pullarkat V, Wasser JS, Beenhouwer D, Gibbs SN, Yermilov I, Broder MS (2020) Tapering thrombopoietin receptor agonists in primary immune thrombocytopenia: expert consensus based on the RAND/UCLA modified Delphi panel method. Res Pract Thromb Haemost 5(1):69–80. 10.1002/rth2.12457 10.1002/rth2.12457 PubMed DOI PMC

Howick J, Chalmers I, Glasziou P, Greenhalgh T, Heneghan C, Liberati A, Moschetti I, Phillips B, Thornton H Explanation of the 2011 Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence (Background Document). Oxford Centre for Evidence-Based Medicine. https://www.cebm.ox.ac.uk/resources/levels-of-evidence/explanation-of-the-2011-ocebm-levels-of-evidence. Accessed August 2022

Guyatt GH (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336(7650):924–926. 10.1136/bmj.39489.470347.AD 10.1136/bmj.39489.470347.AD PubMed DOI PMC

de Villiers MR, de Villiers PJT, Kent AP (2005) The Delphi technique in health sciences education research. Med Teach 27(7):639–643. 10.1080/13611260500069947 10.1080/13611260500069947 PubMed DOI

Neunert CE, Cooper N (2018) Evidence-based management of immune thrombocytopenia: ASH guideline update. Hematology 2018(1):568–575. 10.1182/asheducation-2018.1.568 10.1182/asheducation-2018.1.568 PubMed DOI PMC

Birocchi S, Podda GM, Manzoni M, Casazza G, Cattaneo M (2021) Thrombopoietin receptor agonists for the treatment of primary immune thrombocytopenia: a meta-analysis and systematic review. Platelets 32(2):216–226. 10.1080/09537104.2020.1745168 10.1080/09537104.2020.1745168 PubMed DOI

Cohen I, Goldvaser H, Kirgner I, Leader A, Raanani P, Isakov O, Shepshelovich D (2021) Targeted therapies for immune thrombocytopenic purpura: a meta-analysis of randomized controlled trials. Ann Hematol 100(12):2879–2887. 10.1007/s00277-021-04669-8 10.1007/s00277-021-04669-8 PubMed DOI

Deng J, Hu H, Huang F, Huang C, Huang Q, Wang L, Wu A, Yang J, Qin D, Zou W, Wu J (2021) Comparative efficacy and safety of thrombopoietin receptor agonists in adults with thrombocytopenia: a systematic review and network meta-analysis of randomized controlled trial. Front Pharmacol 12:704093. 10.3389/fphar.2021.704093 10.3389/fphar.2021.704093 PubMed DOI PMC

Wojciechowski P, Wilson K, Nazir J, Pustułka I, Tytuła A, Smela B, Pochopień M, Vredenburg M, McCrae KR, Jurczak W (2021) Efficacy and safety of avatrombopag in patients with chronic immune thrombocytopenia: a systematic literature review and network meta-analysis. Adv Ther 38:3113–3128. 10.1007/s12325-021-01752-4 10.1007/s12325-021-01752-4 PubMed DOI PMC

Yang R, Lin L, Yao H, Ji O, Shen Q (2019) Therapeutic options for adult patients with previously treated immune thrombocytopenia - a systematic review and network meta-analysis. Hematology 24(1):290–299. 10.1080/16078454.2019.1568659 10.1080/16078454.2019.1568659 PubMed DOI

Carpenedo M, Baldacci E, Baratè C, Borchiellini A, Buccisano F, Calvaruso G, Chiurazzi F, Fattizzo B, Giuffrida G, Rossi E, Palandri F, Scalzulli PR, Siragusa SM, Vitucci A, Zaja F (2021) Second-line administration of thrombopoietin receptor agonists in immune thrombocytopenia: Italian Delphi-based consensus recommendations. Ther Adv Hematol 12:1–9. 10.1177/2040620721104836110.1177/20406207211048361 PubMed DOI PMC

González-López TJ, Fernández-Fuertes F, Hernández-Rivas JA, Sánchez-González B, Martínez-Robles V, Alvarez-Román MT, Pérez-Rus G, Pascual C, Bernat S, Arrieta-Cerdán E, Aguilar C, Bárez A, Peñarrubia MJ, Olivera P, Fernández-Rodríguez A, de Cabo E, García-Frade LJ, González-Porras JR (2017) Efficacy and safety of eltrombopag in persistent and newly diagnosed ITP in clinical practice. Int J Hematol 106(4):508–516. 10.1007/s12185-017-2275-4 10.1007/s12185-017-2275-4 PubMed DOI

Meyer O, Richter H, Lebioda A, Schill M (2021) Treatment patterns in adults with immune thrombocytopenia before, during and after use of thrombopoietin receptor agonists: a longitudinal prescription database study from Germany. Hematology 26(1):697–708. 10.1080/16078454.2021.1974203 10.1080/16078454.2021.1974203 PubMed DOI

Mingot-Castellano ME, Caparrós IS, Fernández F, Perera-Alvarez MDM, Jimenez-Bárcenas R, Casaus García A, González-Silva M, Yera-Cobo M, Nieto-Hernandez MM, Rodríguez-Fernandez MJ, Díaz-Canales D (2018) Treatment characteristics, efficacy and safety of thrombopoietin analogues in routine management of primary immune thrombocytopenia. Blood Coagul Fibrinolysis 29(4):374–380. 10.1097/mbc.0000000000000726 10.1097/mbc.0000000000000726 PubMed DOI

Kuter DJ, Newland A, Chong BH, Rodeghiero F, Romero MT, Pabinger I, Chen Y, Wang K, Mehta B, Eisen M (2019) Romiplostim in adult patients with newly diagnosed or persistent immune thrombocytopenia (ITP) for up to 1 year and in those with chronic ITP for more than 1 year: a subgroup analysis of integrated data from completed romiplostim studies. Br J Haematol 185(3):503–513. 10.1111/bjh.15803 10.1111/bjh.15803 PubMed DOI PMC

Tripathi AK, Shukla A, Mishra S, Yadav YS, Yadav DK (2014) Eltrombopag therapy in newly diagnosed steroid non-responsive ITP patients. Int J Hematol 99(4):413–417. 10.1007/s12185-014-1533-y 10.1007/s12185-014-1533-y PubMed DOI

Moulis G, Germain J, Rueter M, Lafaurie M, Aroichane M, Comont T, Mahévas M, Viallard JF, Chèze S, Ebbo M, Audia S, Leclerc-Teffahi S, Sommet A, Beyne-Rauzy O, Michel M, Godeau B, Lapeyre-Mestre M (2022) Eltrombopag in adult patients with immune thrombocytopenia in the real-world in France, including off-label use before 6 months of disease duration: the multicenter, prospective ELEXTRA study. Am J Hematol 97(2):E40-e44. 10.1002/ajh.26404 10.1002/ajh.26404 PubMed DOI PMC

Newland A, Godeau B, Priego V, Viallard JF, López Fernández MF, Orejudos A, Eisen M (2016) Remission and platelet responses with romiplostim in primary immune thrombocytopenia: final results from a phase 2 study. Br J Haematol 172(2):262–273. 10.1111/bjh.13827 10.1111/bjh.13827 PubMed DOI

Snell Taylor SJ, Nielson CM, Breskin A, Saul B, Yu Y, Alam N, Eisen M, Hippenmeyer J, Janssens A, Kozak T, Papadaki HA, Selleslag D, Viallard JF, Feistritzer C, Kaiafa G, Kelsh M, Kilpatrick K, Brookhart MA, McGrath LJ (2021) Effectiveness and safety of romiplostim among patients with newly diagnosed, persistent and chronic immune thrombocytopenia in European clinical practice. Adv Ther 38(5):2673–2688. 10.1007/s12325-021-01727-5 10.1007/s12325-021-01727-5 PubMed DOI PMC

DeSouza S, Angelini D (2021) Updated guidelines for immune thrombocytopenic purpura: expanded management options. Clevel Clin J Med 88(12):664–668. 10.3949/ccjm.88a.2020110.3949/ccjm.88a.20201 PubMed DOI

Matzdorff A, Meyer O, Ostermann H, Kiefel V, Eberl W, Kühne T, Pabinger I, Rummel M (2018) Immune thrombocytopenia - current diagnostics and therapy: recommendations of a Joint Working Group of DGHO, ÖGHO, SGH, GPOH, and DGTI. Oncol Res Treat 41(Suppl 5):1–30. 10.1159/000492187 10.1159/000492187 PubMed DOI

González-Porras JR, Mingot-Castellano ME, Andrade MM, Alonso R, Caparrós I, Arratibel MC, Fernández-Fuertes F, Cortti MJ, Pascual C, Sánchez-González B, Bernat S, Fuertes-Palacio MA, Vázquez-Paganini JA, Olivera PE, Alvarez-Román MT, Jarque I, Cortés M, Martínez-Robles V, Díaz-Gálvez FJ, Calbacho M, Fernández-Miñano C, Garcia-Frade J, González-López TJ (2015) Use of eltrombopag after romiplostim in primary immune thrombocytopenia. Br J Haematol 169(1):111–116. 10.1111/bjh.13266 10.1111/bjh.13266 PubMed DOI

Cantoni S, Carpenedo M, Mazzucconi MG, De Stefano V, Carrai V, Ruggeri M, Specchia G, Vianelli N, Pane F, Consoli U, Artoni A, Zaja F, D’Adda M, Visentin A, Ferrara F, Barcellini W, Caramazza D, Baldacci E, Rossi E, Ricco A, Ciminello A, Rodeghiero F, Nichelatti M, Cairoli R (2018) Alternate use of thrombopoietin receptor agonists in adult primary immune thrombocytopenia patients: a retrospective collaborative survey from Italian hematology centers. Am J Hematol 93(1):58–64. 10.1002/ajh.24935 10.1002/ajh.24935 PubMed DOI

Khellaf M, Viallard JF, Hamidou M, Cheze S, Roudot-Thoraval F, Lefrere F, Fain O, Audia S, Abgrall JF, Michot JM, Dauriac C, Lefort S, Gyan E, Niault M, Durand JM, Languille L, Boutboul D, Bierling P, Michel M, Godeau B (2013) A retrospective pilot evaluation of switching thrombopoietic receptor-agonists in immune thrombocytopenia. Haematologica 98(6):881–887. 10.3324/haematol.2012.074633 10.3324/haematol.2012.074633 PubMed DOI PMC

Lakhwani S, Perera M, Fernández-Fuertes F, Ríos de Paz MA, Torres M, Raya JM, Hernández MT (2017) Thrombopoietin receptor agonist switch in adult primary immune thrombocytopenia patients: a retrospective collaborative survey involving 4 Spanish centres. Eur J Haematol 99(4):372–377. 10.1111/ejh.12932 10.1111/ejh.12932 PubMed DOI

Al-Samkari H, Jiang D, Gernsheimer T, Liebman H, Lee S, Wojdyla M, Vredenburg M, Cuker A (2022) Adults with immune thrombocytopenia who switched to avatrombopag following prior treatment with eltrombopag or romiplostim: a multicentre US study. Br J Haematol 197(3):359–366. 10.1111/bjh.18081 10.1111/bjh.18081 PubMed DOI PMC

Kuter DJ, Macahilig C, Grotzinger KM, Poston SA, Wang PF, Dawson KL, Ward M (2015) Treatment patterns and clinical outcomes in patients with chronic immune thrombocytopenia (ITP) switched to eltrombopag or romiplostim. Int J Hematol 101(3):255–263. 10.1007/s12185-014-1731-7 10.1007/s12185-014-1731-7 PubMed DOI

Cooper N, Hill QA, Grainger J, Westwood JP, Bradbury C, Provan D, Thachil J, Ramscar N, Roy A (2021) Tapering and discontinuation of thrombopoietin receptor agonist therapy in patients with immune thrombocytopenia: results from a modified Delphi panel. Acta Haematol 144(4):418–426. 10.1159/000510676 10.1159/000510676 PubMed DOI PMC

Wire MB, Bruce J, Gauvin J, Pendry CJ, McGuire S, Qian Y, Brainsky A (2012) A randomized, open-label, 5-period, balanced crossover study to evaluate the relative bioavailability of eltrombopag powder for oral suspension (PfOS) and tablet formulations and the effect of a high-calcium meal on eltrombopag pharmacokinetics when administered with or 2 hours before or after PfOS. Clin Ther 34(3):699–709. 10.1016/j.clinthera.2012.01.011 10.1016/j.clinthera.2012.01.011 PubMed DOI

Afdhal NH, Giannini EG, Tayyab G, Mohsin A, Lee JW, Andriulli A, Jeffers L, McHutchison J, Chen PJ, Han KH, Campbell F, Hyde D, Brainsky A, Theodore D (2012) Eltrombopag before procedures in patients with cirrhosis and thrombocytopenia. N Engl J Med 367(8):716–724. 10.1056/NEJMoa1110709 10.1056/NEJMoa1110709 PubMed DOI

Terrault NA, Hassanein T, Howell CD, Joshi S, Lake J, Sher L, Vargas H, McIntosh J, Tang S, Jenkins TM (2014) Phase II study of avatrombopag in thrombocytopenic patients with cirrhosis undergoing an elective procedure. J Hepatol 61(6):1253–1259. 10.1016/j.jhep.2014.07.007 10.1016/j.jhep.2014.07.007 PubMed DOI

Terrault N, Chen YC, Izumi N, Kayali Z, Mitrut P, Tak WY, Allen LF, Hassanein T (2018) Avatrombopag before procedures reduces need for platelet transfusion in patients with chronic liver disease and thrombocytopenia. Gastroenterology 155(3):705–718. 10.1053/j.gastro.2018.05.025 10.1053/j.gastro.2018.05.025 PubMed DOI

Kurokawa T, Murata S, Ohkohchi N (2016) Stable liver function during long-term administration of eltrombopag, a thrombopoietin receptor agonist, in patients with chronic liver disease. Tohoku J Exp Med 240(4):277–279. 10.1620/tjem.240.277 10.1620/tjem.240.277 PubMed DOI

Flisiak R, Antonov K, Drastich P, Jarcuska P, Maevskaya M, Makara M, Puljiz Ž, Štabuc B, Trifan A (2021) Practice guidelines of the Central European Hepatologic Collaboration (CEHC) on the use of thrombopoietin receptor agonists in patients with chronic liver disease undergoing invasive procedures. J Clin Med 10(22):5419. 10.3390/jcm10225419 PubMed PMC

Pantic N, Suvajdzic-Vukovic N, Virijevic M, Pravdic Z, Sabljic N, Adzic-Vukicevic T, Mitrovic M (2022) Coronavirus disease 2019 in patients with chronic immune thrombocytopenia on thrombopoietin receptor agonists: new perspectives and old challenges. Blood Coag Fibrinol 33(1):51–55. 10.1097/MBC.000000000000110910.1097/MBC.0000000000001109 PubMed DOI

Visser C, Swinkels M, van Werkhoven ED, Croles FN, Noordzij-Nooteboom HS, Eefting M, Last-Koopmans SM, Idink C, Westerweel PE, Santbergen B, Jobse PA, Baboe F, Consortium R-I, Te Boekhorst PAW, Leebeek FWG, Levin M-D, Kruip MJHA, Jansen AJG (2022) COVID-19 vaccination in patients with immune thrombocytopenia. Blood advances 6(6):1637–1644. 10.1182/bloodadvances.2021006379 10.1182/bloodadvances.2021006379 PubMed DOI PMC

Sahu KK, Siddiqui AD, Rezaei N, Cerny J (2020) Challenges for management of immune thrombocytopenia during COVID-19 pandemic. J Med Virol 92(11):2277–2282. 10.1002/jmv.26251 10.1002/jmv.26251 PubMed DOI PMC

Michel M, Ruggeri M, Gonzalez-Lopez TJ, Alkindi S, Cheze S, Ghanima W, Tvedt THA, Ebbo M, Terriou L, Bussel JB, Godeau B (2020) Use of thrombopoietin receptor agonists for immune thrombocytopenia in pregnancy: results from a multicenter study. Blood 136(26):3056–3061. 10.1182/blood.2020007594 10.1182/blood.2020007594 PubMed DOI

Yu Y, Wang M, Hou Y, Qin P, Zeng Q, Yu W, Guo X, Wang J, Wang X, Liu G, Chu X, Yang L, Feng Y, Zhou F, Sun Z, Zhang M, Wang X, Wang Z, Ran X, Zhao H, Wang L, Zhang H, Bi K, Li D, Yuan C, Xu R, Wang Y, Zhou Y, Peng J, Liu XG, Hou M (2020) High-dose dexamethasone plus recombinant human thrombopoietin vs high-dose dexamethasone alone as frontline treatment for newly diagnosed adult primary immune thrombocytopenia: a prospective, multicenter, randomized trial. Am J Hematol 95(12):1542–1552. 10.1002/ajh.25989 10.1002/ajh.25989 PubMed DOI

Gómez-Almaguer D, Herrera-Rojas MA, Jaime-Pérez JC, Gómez-De León A, Cantú-Rodríguez OG, Gutiérrez-Aguirre CH, Tarín-Arzaga L, Hernández-Reyes J, Ruiz-Arguelles GJ (2014) Eltrombopag and high-dose dexamethasone as frontline treatment of newly diagnosed immune thrombocytopenia in adults. Blood 123(25):3906–3908. 10.1182/blood-2014-01-549360 10.1182/blood-2014-01-549360 PubMed DOI

Zhang L, Zhang M, Du X, Cheng Y, Cheng G (2020) Safety and efficacy of eltrombopag plus pulsed dexamethasone as first-line therapy for immune thrombocytopenia. Br J Haematol 189(2):369–378. 10.1111/bjh.16327 10.1111/bjh.16327 PubMed DOI

Kuter DJ (2022) The structure, function, and clinical use of the thrombopoietin receptor agonist avatrombopag. Blood Rev 53:100909. 10.1016/j.blre.2021.100909 10.1016/j.blre.2021.100909 PubMed DOI

Cines DB, Levine LD (2017) Thrombocytopenia in pregnancy. Hematology 2017(1):144–151. 10.1182/asheducation-2017.1.144 10.1182/asheducation-2017.1.144 PubMed DOI PMC

Agarwal N, Mangla A (2021) Thrombopoietin receptor agonist for treatment of immune thrombocytopenia in pregnancy: a narrative review. Therapeutic Advances in Hematology 12:1–17. 10.1177/20406207211001139 PubMed PMC

Bhattacharjee S, Banerjee M (2020) Immune thrombocytopenia secondary to COVID-19: a systematic review. SN Compr Clin Med 2(11):2048–2058. 10.1007/s42399-020-00521-8 10.1007/s42399-020-00521-8 PubMed DOI PMC

Berger B, Rodgers G (2021) ITP secondary to COVID-19: a comprehensive review of reported cases. Abstract PB0169. Presented at the ISTH; July 17–21, Philadelphia, PA. https://abstracts.isth.org/abstract/itp-secondary-to-covid-19-a-comprehensive-review-of-reported-cases/

Pavord S, Thachil J, Hunt BJ, Murphy M, Lowe G, Laffan M, Makris M, Newland AC, Provan D, Grainger JD, Hill QA (2020) Practical guidance for the management of adults with immune thrombocytopenia during the COVID-19 pandemic. Br J Haematol 189(6):1038–1043. 10.1111/bjh.16775 10.1111/bjh.16775 PubMed DOI PMC

Pavord S, Thachil J, Hunt BJ, Murphy M, Lowe G, Laffan M, Makris M, Newland AC, Provan D, Grainger JD, Hill QA (2020) Practical guidance for the management of adults with immune thrombocytopenia during the COVID-19 pandemic. Br J Haematol 189(6):1038–1043. 10.1111/bjh.16775 10.1111/bjh.16775 PubMed DOI PMC

Shah SRA, Dolkar S, Mathew J, Vishnu P (2021) COVID-19 vaccination associated severe immune thrombocytopenia. Exp Hematol Oncol 10(1):42. 10.1186/s40164-021-00235-0 10.1186/s40164-021-00235-0 PubMed DOI PMC

Wang L, Gao Z, Chen XP, Zhang HY, Yang N, Wang FY, Guan LX, Gu ZY, Zhao SS, Luo L, Wei HP, Gao CJ (2016) Efficacy and safety of thrombopoietin receptor agonists in patients with primary immune thrombocytopenia: a systematic review and meta-analysis. Sci Rep 6:39003. 10.1038/srep39003 10.1038/srep39003 PubMed DOI PMC

Cuker A, Liebman HA (2021) Corticosteroid overuse in adults with immune thrombocytopenia: cause for concern. Res Pract Thromb Haemost 5(6):e12592–e12592. 10.1002/rth2.12592 10.1002/rth2.12592 PubMed DOI PMC

Michel M, te Boekhorst PAW, Janssens A, Pabinger-Fasching I, Sanz MA, Nie K, Kreuzbauer G (2011) Reduced corticosteroid use in adult patients with primary immune thrombocytopenia receiving romiplostim. Hematology (Amsterdam, Netherlands) 16(5):274–277. 10.1179/102453311X13025568942005 10.1179/102453311X13025568942005 PubMed DOI PMC