{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T13:05:35Z","timestamp":1792760735986,"version":"4.5.0"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,5,29]],"date-time":"2023-05-29T00:00:00Z","timestamp":1685318400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Br J Haematol"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Summary<\/jats:title><jats:p>Combining drugs could be an effective option for treating multirefractory ITP, that is, patients not responding to rituximab, thrombopoietin receptor agonists (TPO\u2010RA) and splenectomy. We conducted a retrospective, multicenter, observational study including multirefractory ITP patients who received a combination of a TPO\u2010RA and an immunosuppressive drug. We included 39 patients (67% women, median age 59\u2009years [range 21\u201396]), with a median ITP duration of 57\u2009months [3\u2013393] and a median platelet count at initiation of 10\u2009\u00d7\u200910<jats:sup>9<\/jats:sup>\/L [1\u201335]. The combination regimen was given for a median duration of 12\u2009months [1\u2013103] and included eltrombopag (51%) or romiplostim (49%), associated with mycophenolate mofetil (54%), azathioprine (36%), cyclophosphamide (5%), cyclosporin (3%) or everolimus (3%). Overall, 30 patients (77%) achieved at least a response (platelet count \u226530\u2009\u00d7\u200910<jats:sup>9<\/jats:sup>\/L and at least doubling baseline during at least 3\u2009months), including 24 complete responses (platelet count &gt;100\u2009\u00d7\u200910<jats:sup>9<\/jats:sup>\/L during at least 3\u2009months) with a median time to response of 30\u2009days [7\u2013270] and a median duration of response of 15\u2009months [4\u201363]. Severe adverse event related to ITP treatment was observed in 31%. In conclusion, this study confirms that some patients with multirefractory ITP can achieve long lasting response with this combination.<\/jats:p>","DOI":"10.1111\/bjh.18893","type":"journal-article","created":{"date-parts":[[2023,5,29]],"date-time":"2023-05-29T22:58:01Z","timestamp":1685401081000},"page":"883-889","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Combining thrombopoietin receptor agonists with immunosuppressive drugs in adult patients with multirefractory immune thrombocytopenia, an update on the French experience"],"prefix":"10.1111","volume":"202","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3964-4968","authenticated-orcid":false,"given":"Etienne","family":"Crickx","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Centre national de r\u00e9f\u00e9rence des cytop\u00e9nies auto\u2010immunes de l'adulte, H\u00f4pital Henri Mondor, F\u00e9d\u00e9ration Hospitalo\u2010Universitaire TRUE InnovaTive theRapy for immUne disordErs, Assistance Publique H\u00f4pitaux de Paris (AP\u2010HP) Universit\u00e9 Paris Est Cr\u00e9teil  Cr\u00e9teil France"},{"name":"Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Imagine Institute Universit\u00e9 Paris Cit\u00e9, INSERM UMR U1163  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikael","family":"Ebbo","sequence":"additional","affiliation":[{"name":"Internal Medicine Department H\u00f4pital la Timone, Assistance Publique H\u00f4pitaux de Marseille, Aix Marseille Universit\u00e9  Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Etienne","family":"Rivi\u00e8re","sequence":"additional","affiliation":[{"name":"Internal Medicine and Infectious Diseases Unit, Haut\u2010Leveque Hospital University Hospital Centre of Bordeaux  Pessac France"},{"name":"INSERM U1034 Bordeaux University  Pessac Cedex 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