Switching patients with immune thrombocytopenia ( ITP) to avatrombopag from other thrombopoietin receptor agonists: The real‐world experience of the Spanish ITP Group ( GEPTI )

Summary Avatrombopag is a thrombopoietin receptor agonist (TPO‐RA) suitable for patient‐centred care. Avatrombopag achieved lasting platelet count (PC) increases in small series of immune thrombocytopenia (ITP) patients in whom other TPO‐RAs had failed. We recruited 208 patients with ITP who switched from eltrombopag or romiplostim to avatrombopag due to ineffectiveness (115 55.3%), convenience (66 31.7%) or treatment‐emergent adverse events (TEAEs) (27 13.0%). Patients were followed up for 63.9 (31.1–100.4) weeks (median interquartile range). Ninety‐two per cent of switchers due to ineffectiveness who had baseline PC <50 × 10 9 /L responded to avatrombopag (PC ≥50 × 10 9 /L with doubling of baseline values). Response was maintained in 81.2% of patients after 56.4 (24.6–90.2) weeks. Ninety‐two per cent of switchers due to convenience or TEAEs maintained a long‐term response. Fifty‐one per cent of switchers due to TPO‐RA failure who used concomitant medications discontinued these while on avatrombopag. In switchers due to convenience or TEAEs, the maintenance dose decreased from 140 (140–140) to 80 (60–140) mg/week. Fourteen patients (6.7%) discontinued avatrombopag due to TEAEs. The thromboembolism rate was 3.8%. No new safety concerns arose. In this large real‐world cohort, switching from eltrombopag or romiplostim to avatrombopag safely induced durable PC recovery.