How do patients perceive the treatment of ITP with romiplostim?
Romiplostim, along with eltrombopag and avatrombopag, belongs to the group of thrombopoietin receptor agonists (TPO-RA) used in the second line of treatment for immune thrombocytopenia (ITP). Its efficacy and safety are confirmed by numerous studies, but how do patients perceive its use and to what extent does it improve their quality of life? This was the focus of a review article by authors from the American Baylor College of Medicine.
Substances from the TPO-RA group and their basic differences
If there is a need to start the second line of treatment for ITP, the attending physician can choose from 3 substances from the TPO-RA group, among others:
Romiplostim is an Fc-peptide fusion protein administered once a week subcutaneously. Initially, dose titration is required, during which platelet levels should be checked weekly. Eltrombopag is a non-peptide molecule taken orally daily, as is avatrombopag.
While eltrombopag requires dietary restrictions and carries a risk of elevated liver tests, this is not the case with avatrombopag. The dietary restriction is aimed at the interaction of eltrombopag with polyvalent cations, which reduces its absorption. For this reason, it should be taken at least 2 hours before or at least 4 hours after consuming dairy products, foods containing calcium, antacids, or dietary supplements with polyvalent cations (Ca, Al, Fe, Mg, Se, Zn...). Avatrombopag is currently only indicated for adults.
These basic differences between individual TPO-RAs should be considered when selecting a drug, and patients should be informed about them and their preferences should be determined. Choosing the right drug can influence their adherence to treatment and quality of life.
Quality of life during ITP treatment
Health-related quality of life (HRQoL) is generally lower in patients with ITP compared to the healthy population, for both adults and children. In the case of children, the caregivers are also affected by the disease.
According to available data, HRQoL did not significantly increase with the use of romiplostim in children, but the burden on caregivers decreased. It is assumed that while the caregiver perceives a reduction in the fear of bleeding due to the therapeutic effect and increase in platelet count, children are limited by other factors such as doctor visits or blood draws.
In adults, ITP therapy generally leads to an improvement in HRQoL. More specific data is obtained using the ITP-PAQ (Immune Thrombocytopenia Purpura Patient Assessment Questionnaire), which assesses physical health, symptoms including bleeding, fatigue, hardship, activity, fear, emotional and mental health, female reproductive health, social activity, and quality of life in general.
In two placebo-controlled studies, patients taking romiplostim showed improvement in a total of 7 categories: symptoms, hardship, fear, activity, mental health, social activity, and menstrual symptoms in women. In other categories, there were no significant differences between the placebo and romiplostim groups. In another study comparing romiplostim and standard care (SOC), there was also an improvement in 7 parameters: symptoms, hardship, activity, mental health, fear, social activity, and general quality of life.
Conclusion
The administration of romiplostim can improve the quality of life of a patient with ITP in several aspects. However, when selecting a second-line drug, it is important to consider the patient's preferences and make them aware of all options.
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Source: Gilbert M. M., Grimes A. B., Kim T. O., Despotovic J. M. Romiplostim for the treatment of immune thrombocytopenia: spotlight on patient acceptability and ease of use. Patient Prefer Adherence 2020 Jul 22; 14: 1237−1250, doi: 10.2147/PPA.S192481.
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