{
  "abstract": "Background: Immune thrombocytopenia (ITP) frequently evolves into a chronic condition in adult patients. Some of these patients do not respond to multiple lines of therapy, which represents a clinical challenge. Eltrombopag and romiplostim are thrombopoietin receptor agonists (TPO-RAs), and as these agents bind to distinct sites on TPO receptor, there is a biological rationale for potential synergistic effects when used combined. However, data on simultaneous use of eltrombopag and romiplostim are limited to a few case reports. Aims: To report on three cases with ITP refractory to multiple lines of therapy, who were concomitantly treated with eltrombopag and romiplostim. Methods: Combined therapy was defined as the concomitant administration of eltrombopag and romiplostim. After starting the combined therapy, patients were periodically monitored until discontinuation of combined therapy, or January 2026. Each outpatient visit included assessment for bleeding and treatment-related adverse events, complete blood count, and hepatic and renal function. Approved informed consent was obtained. Results: All patients were female, with 1 patient having common variable immunodeficiency as baseline comorbidity. All patients had prior exposure to multiple therapy options, alone or in combination (e.g., corticosteroids, IV immunoglobulin, splenectomy, rituximab, mycophenolate-mofetil, azathioprine, dapsone). The three patients had previously received eltrombopag or romiplostim, either alone or combined with some of the above-mentioned drugs. Despite multiple therapies, all patients had persistently low platelet count (PC) (often ≤10.0 × 10 9 /L), with bleeding on several occasions. The age at the start of combined therapy ranged from 21 to 35 years, and the time from ITP diagnosis to the start of combined therapy ranged from 28 to 192 months. The maximum dose to achieve complete response or until discontinuation of combined therapy ranged from 50 mg to 75 mg for eltrombopag and from 8 mcg/Kg to 10 mcg/Kg for romiplostim. One patient received the combined therapy for nearly 50 months; she achieved complete response, although exhibited decreased PC (≤10.0 × 10 9 /L) during infectious episodes, followed by recovery after infection treatment. The other patient, who was corticosteroid-dependent, did not respond to the combined therapy, which was discontinued after 5.5 months. The third patient demonstrated substantial improvement in PC (around 100.0 × 10 9 /L) throughout the follow-up with combined therapy of almost 5 months. No clinically significant bleeding and treatment related adverse events were observed. Discussion/Conclusion: In this small case series comprising patients with ITP refractory to multiple therapy lines, combined therapy with eltrombopag and romiplostim appeared to be well tolerated, with 2 of the 3 patients achieving substantial improvement in PC. These findings suggest that combined TPO-RA therapy might be an option in highly selected patients, with further investigation being warranted.",
  "abstract_shown": true,
  "affiliations": [
    "Universidade de São Paulo (USP), São Paulo, Brazil"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Carolina Wermelinger ERTHAL"
    },
    {
      "affs": [
        0
      ],
      "name": "Caroline BUENO"
    },
    {
      "affs": [
        0
      ],
      "name": "Gabriel PESSOA"
    },
    {
      "affs": [
        0
      ],
      "name": "João DIAS"
    },
    {
      "affs": [
        0
      ],
      "name": "Rebeca FARIAS"
    },
    {
      "affs": [
        0
      ],
      "name": "Paula PRESTES"
    },
    {
      "affs": [
        0
      ],
      "name": "Bianca STEFANELLO"
    },
    {
      "affs": [
        0
      ],
      "name": "Erica OKAZAKI"
    },
    {
      "affs": [
        0
      ],
      "name": "Fernanda ORSI"
    },
    {
      "affs": [
        0
      ],
      "name": "Vanderson ROCHA"
    },
    {
      "affs": [
        0
      ],
      "name": "Vania MORELLI"
    },
    {
      "affs": [
        0
      ],
      "name": "Paula VILLAÇA"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/amy18pd6ke0n6.bib",
  "cited_by": 0,
  "doi": "10.1016/j.htct.2026.108050",
  "fulltext_url": "http://www.sciencedirect.com/science/article/pii/S2531137926017979",
  "id": "amy18pd6ke0n6",
  "issns": [
    "2531-1379",
    "2531-1387"
  ],
  "landing_url": "https://doi.org/10.1016/j.htct.2026.108050",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC633-647.5"
    ],
    [
      "openalex",
      "2720|Platelet Disorders and Treatments"
    ]
  ],
  "openalex": "W7223140802",
  "pdf_url": "https://www.sciencedirect.com/science/article/pii/S2531137926017979/pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-23",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/amy18pd6ke0n6.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:43:27Z",
      "native_id": "d1d70a1705714aa7bd5f77f73aea0b1d",
      "source": "doaj",
      "url": "https://doi.org/10.1016/j.htct.2026.108050"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "lcc:RC633-647.5",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "COMBINED THERAPY WITH ELTROMBOPAG AND ROMIPLOSTIM IN IMMUNE THROMBOCYTOPENIA REFRACTORY TO MULTIPLE LINES OF THERAPY - A CASE SERIES",
  "title_text": "COMBINED THERAPY WITH ELTROMBOPAG AND ROMIPLOSTIM IN IMMUNE THROMBOCYTOPENIA REFRACTORY TO MULTIPLE LINES OF THERAPY - A CASE SERIES",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:43:27Z",
  "url": "https://research.draconitic.com/paper/amy18pd6ke0n6",
  "venue": "Hematology, Transfusion and Cell Therapy",
  "versions": []
}