Efficacy of remiplostim in petients with chronic immune thrombocytopenic purpura : a double-blind randomised controlled trial  

Oleh:

Kuter, David J. ; Bussel, James B. ; Lyons, Roger M. ; Pullarkat, Vinod ; Gernsheimer, Terry B. ; and Others

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The Lancet (keterangan: ada di Proquest) vol. 371 no. 9610 (Feb. 2008), page 395.

Ketersediaan

Perpustakaan FK Nomor Panggil: L01.K.2008.02 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

Background Chronic immune thrombocytopenic purpura (ITP) is characterised by accelerated platelet destruction and decreased platelet production. Short term administration of the thrombopoiesis-stimulating protein, romiplostim, has been shown ti increase platelet counts in most patients with chronic ITP. We assessed the long term administration of romiplostim in splenectomised and non splenectomised patients with ITP. Methods In two parallel trials, 63 splenectomised and 62 non splenectomised patients with ITP and a mean of three platelet counts 30x109/L or less were randomly assigned 2:1 to subcutaneous injections of romiplostim (n=42 in splenectomised study and n=41 in non-splenectomised study) or placebo (n=21 in both study) every week for 24 weeks. Doses of study drugs were adjusted to maintain platelet counts of 50x109/L to 200x109/L. The primary obcejtives were to assess the efficacy of romiplostim as measured by a durable platelet response (platelet count >50x109/L during 6 or more of the last 8 weeks of treatment) and treatment safety. Analysis was per protocol. These studies are registered with Clinical Trials. Findings A durable platelet response was achieved by 16 of 42 splenectomised patients given romplostim versus none of 21 given placebo ( difference in porpotion of patients responding 38%[95% CI 23.4-52.8], p=0.0013), and by 25 of 41 non-splenectomised patients given romplostim versus one of given placebo (56% [38.7-73.7], p<0.0001). The overall platelet response rate (either durable or transient platelet response) was noted in 88% (36/41) of non-splenectomised and 79% (33/42) of splenectomised patients given romiplostim compared with 14% (three of 21) of non-splenectomised and no splenectomised patients given placebo (p<0·0001). Patients given romiplostim achieved platelet counts of 50×109/L or more on a mean of 13·8 (SE 0·9) weeks (mean 12·3 [1·2] weeks in splenectomised group vs 15·2 [1·2] weeks in non-splenectomised group) compared with 0·8 (0·4) weeks for those given placebo (0·2 [0·1] weeks vs 1·3 [0·8] weeks). 87% (20/23) of patients given romiplostim (12/12 splenectomised and eight of 11 non-splenectomised patients) reduced or discontinued concurrent therapy compared with 38% (six of 16) of those given placebo (one of six splenectomised and five of ten non-splenectomised patients). Adverse events were much the same in patients given romiplostim and placebo. No antibodies against romiplostim or thrombopoietin were detected. Interpretation Romiplostim was well tolerated, and increased and maintained platelet counts in splenectomised and non-splenectomised patients with ITP. Many patients were able to reduce or discontinue other ITP medications. Stimulation of platelet production by romiplostim may provide a new therapeutic option for patients with ITP.

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