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. 2023 Feb 24;102(4):715–727. doi: 10.1007/s00277-023-05114-8

Table 3.

Summary of expert consensus statements on the use of TPO-RAs in adult ITP

1 Approved TPO-RAs (eltrombopag, romiplostim, or avatrombopag) are the preferred second-line treatment for chronic ITP patients who are refractory to a previous treatment (e.g., corticosteroids or immunoglobulins)
2 Consider TPO-RAs for newly diagnosed ITP (< 3 months) or persistent ITP (3–12 months)
3 Consider switching TPO-RA if a patient with chronic ITP fails to respond, loses response, or due to inconvenience, platelet fluctuations, or adverse events with one or two previous TPO-RAs
4 Consider a dose-reduction/tapering regimen with possible discontinuation of TPO for individual ITP patients with sustained platelet counts above 100 × 109/L (CR) with TPO-RAs and no bleeding for at least 12 months in the absence of other concomitant treatments
5 Romiplostim or avatrombopag may be preferable to eltrombopag for specific ITP patients with dietary requirements
6 TPO-RAs with very low risk of hepatic side effects may be preferable (e.g., avatrombopag) for patients with chronic ITP and concomitant liver dysfunction
7 TPO-RAs might be (rarely) considered for temporary off-label usage in individual ITP patients during late-stage pregnancy (e.g., for patients with severe, refractory ITP or contraindication to steroids and IVIG)