Steroids versus Eltrombopag for first and second-line treatment of adult immune thrombocytopenia

Introduction: Primary thrombocytopenia immune (PTI) is characterized by the progressive destruction of platelets through the formation of antibodies on the different glycoproteins of the platelet membrane. The first-line treatment is steroids. Eltrombopag is an oral thrombopoietin receptor agonist that stimulates Thromboprotein Receptor Agonists signaling, stimulating the production of functional platelets. It is considered a tolerable drug, but it warrants monitoring of liver function and cell counts due to the risk of fibrosis. Objective: To evaluate the response of steroids as a first-line treatment and Eltrombopag as a second-line regimen. Methods: Retrospective, observational study based on the clinical records of patients diagnosed with PTI from 2018 to 2023. Results: Two hundred and forty-two clinical records of patients were studied; 192 were considered first-line treatment, and 50 received Eltrombopag as second-line therapy. About 69.8% of patients treated with steroids achieved complete remission, compared to 80% of those in the Eltrombopag group. 64% of Eltrombopag patients achieved complete response, 24% had partial response, and 12% had stable disease. Conclusions: Eltrombopag is a safe treatment with a high proportion of responses in patients without a splenectomy history and without the combined use of steroids. This suggests that it could be used as a first line of treatment.