Eltrombopag in the treatment of immune thrombocytopenia secondary to SLE: A double-edged sword

Objective To evaluate the efficacy and safety of eltrombopag in patients with systemic lupus erythematosus (SLE)-associated immune thrombocytopenia, with a particular focus on thrombotic risk. Methods We conducted a retrospective cohort study of 23 patients with SLE-associated thrombocytopenia treated with eltrombopag. Baseline clinical characteristics, treatment patterns, and outcomes were collected. The primary outcomes were sustained platelet response (≥50 ×10 9 /L at last follow-up) and occurrence of thrombotic events. Exploratory analyses assessed associations between antiphospholipid antibody (aPL) status and thrombosis. Results The mean age was 33.7 ± 12.3 years, and 65.2% were female. aPL positivity was present in 52.2% of patients. A sustained platelet response was achieved in 65.2% of patients, and 21.7% were successfully weaned off corticosteroids. Thrombotic events occurred in 8 patients (34.8%), with arterial events accounting for 50% of cases. The median time to thrombosis was 5.5 months. Thrombosis occurred across a range of platelet counts and was not consistently associated with thrombocytosis. A higher proportion of thrombotic events was observed in aPL-positive patients (41.7% vs 27.3%), although this did not reach statistical significance (OR 1.90, 95% CI 0.33–11.01, p = 0.667). Conclusion Eltrombopag was associated with platelet response in this cohort. Thrombosis was numerically more common in aPL-positive patients, but the small sample and imprecise estimate preclude conclusions about its independent contribution. Without a comparator group, whether these events reflect eltrombopag, the prothrombotic milieu of SLE and aPL antibodies, or their interaction cannot be determined.