Use Of Thrombopoietin Receptor Agonist For Immune Thrombocytopenia In Pregnancy: Results From A Multicenter Study

In recent publication in the Journal Blood, by the American Society of Hematology, investigators wanted to determine the safety and efficacy of thrombopoietin receptor agonist for immune thrombocytopenia in the setting of pregnancy. There is generally discouragement with use of these agents in pregnancy, given concerns about placental cross. 

A multicenter observational and retrospective study was conducted.  Results from 15 pregnant women with ITP which included 17 pregnancies and 18 infants treated with eltrimbopag, n=8, romiplostim, n= 7, during pregnancy. There were also 2 patients with secondary ITP. The median time of thrombopoietin receptor agonist exposure was 4.4weeks during pregnancy.  

The indication for initiation of a TPO mimetic was preparation for delivery in 10/17 (58%) pregnancies whereas 4 patients had chronic refractory symptomatic ITP and 3 were on eltrombopag when pregnancy started.

No thromboembolic events among mothers were reported while on thrombopoietin receptor agonist therapy. No fetal or neonatal complications were observed.  There was one case of neonatal thrombocytosis, however.  Responses to therapy were seen in 77% of cases, mostly on combination therapy with other agents.  Combination therapy was needed in 70% of responders.  

Based off these findings, the authors concluded that temporary off-label use of thrombopoietin receptor agonist for severe or refractory ITP during pregnancy appears to be safe for both mother and neonate and is likely to be helpful before delivery. Further studies are needed.