{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T07:33:54Z","timestamp":1767598434854,"version":"build-2065373602"},"reference-count":38,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2012,1,6]],"date-time":"2012-01-06T00:00:00Z","timestamp":1325808000000},"content-version":"vor","delay-in-days":554,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2010,7]]},"abstract":"<jats:p>\n                    Idiopathic thrombocytopenic purpura (ITP) is a platelet disorder that affects approximately 1 in 10,000 people. In adults, the rate of spontaneous remission is only 5%, and generally, it is a chronic disease persisting for more than 6 months. Chronic refractory ITP may be defined as the failure of any modality to keep the platelet count above 20 \u00d7 10\n                    <jats:sup>3<\/jats:sup>\n                    \/mm\n                    <jats:sup>3<\/jats:sup>\n                    for an appreciable time without unacceptable toxicity. Many pharmacologic treatments have been used to manage chronic refractory ITP by attempting to increase platelet counts by decreasing the rate of destruction of these cells. They include, but are not limited to, azathioprine, danazol, dapsone, combination chemotherapy cyclosporine, and rituximab. However, these therapies offer modest response rates and can cause adverse events that necessitate drug discontinuation. The recent United States Food and Drug Administration approval of the thrombo\u2010poietin mimetics, romiplostim and eltrombopag, has provided clinicians with a novel approach for treating chronic refractory ITP By stimulating platelet production, these drugs offer patients with this disease an alternative to the other agents. The preapproval phase III study with subcutaneous romiplostim showed significantly higher overall response rates versus placebo in both splenectomized and nonsplenectomized patients (83% for romiplostim vs 7% for placebo, p&lt;0.0001). Twenty\u2010five percent of patients receiving romiplostim achieved a platelet count greater than 50 \u00d7 10\n                    <jats:sup>3<\/jats:sup>\n                    \/mm\n                    <jats:sup>3<\/jats:sup>\n                    after 1 week, and 50% achieved this platelet count within 2\u20133 weeks. The preapproval phase III study with oral eltrombopag demonstrated that 70% of patients receiving 50 mg\/day and 81% of patients receiving 75 mg\/day achieved a platelet count of at least 50 \u00d7 10\n                    <jats:sup>3<\/jats:sup>\n                    \/mm\n                    <jats:sup>3<\/jats:sup>\n                    by day 43 (p&lt;0.001 vs placebo for both 50 and 75 mg). Forty\u2010four percent and 62% of patients achieved a platelet count of at least 50 \u00d7 10\n                    <jats:sup>3<\/jats:sup>\n                    \/mm\n                    <jats:sup>3<\/jats:sup>\n                    by day 8 with eltrombopag 50 and 75 mg\/day, respectively. When deciding which of these agents to prescribe, considerations include oral versus injectable dosage form, adverse\u2010event profiles, and patient adherence with both taking the drug and keeping clinic appointments for monitoring of platelet counts. Several studies are under way to evaluate these drugs in chronic refractory ITP as well as other disease states. Long\u2010term data will also be needed to assess the safety and efficacy of these agents.\n                  <\/jats:p>","DOI":"10.1592\/phco.30.7.666","type":"journal-article","created":{"date-parts":[[2010,6,24]],"date-time":"2010-06-24T09:20:27Z","timestamp":1277371227000},"page":"666-683","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Treatment Options for Chronic Refractory Idiopathic Thrombocytopenic Purpura in Adults: Focus on Romiplostim and Eltrombopag"],"prefix":"10.1002","volume":"30","author":[{"given":"Jyoti D.","family":"Chouhan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon D.","family":"Herrington","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2012,1,6]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-126-4-199702150-00010"},{"key":"e_1_2_1_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra010501"},{"key":"e_1_2_1_4_2","first-page":"2269","volume-title":"Hematology: basic principles and practice","author":"Bussel J.","year":"2005"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2006-10-019315"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-12-4598"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.1990.tb02569.x"},{"key":"e_1_2_1_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199304293281703"},{"key":"e_1_2_1_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200105033441815"},{"key":"e_1_2_1_10_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V85.2.351.351"},{"key":"e_1_2_1_11_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.2001.02893.x"},{"key":"e_1_2_1_12_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V99.4.1482"},{"key":"e_1_2_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2003.12.024"},{"key":"e_1_2_1_14_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2141.1997.412687.x"},{"key":"e_1_2_1_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.20515"},{"key":"e_1_2_1_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2141.2004.04889.x"},{"key":"e_1_2_1_17_2","unstructured":"U.S. Food and Drug Administration.FDA approves first bone marrow stimulator to treat immune\u2010related low platelet counts August 2008. 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