TY - JOUR
T1 - The ‘Stop TPO-RA in ITP Patients’ study
T2 - Clinical and immune modulatory effects of romiplostim tapering
AU - Nelson, Vivianne S.
AU - Amini, Sufia N.
AU - Netelenbos, Tanja
AU - Kartachova, Marina S.
AU - Schutgens, Roger E.G.
AU - Visser, Otto
AU - Westerweel, Peter E.
AU - Zwaginga, Jaap J.
AU - Hofstede-van Egmond, Suzanne
AU - Kapur, Rick
AU - de Haas, Masja
AU - Porcelijn, Leendert
AU - Schipperus, Martin R.
N1 - Publisher Copyright:
© 2025 British Society for Haematology and John Wiley & Sons Ltd.
PY - 2025/6
Y1 - 2025/6
N2 - Sustained remissions off-treatment (SROTs) after tapering of thrombopoietin receptor agonists (TPO-RAs) have been reported in 15%–50% of patients with immune thrombocytopenia (ITP). The STIP (Stop TPO-Receptor Agonist in ITP Patients) study is a prospective trial aimed to investigate the clinical effects of romiplostim tapering. Adult patients (22/40) with ITP ≥3 months received romiplostim for 1 year, were tapered and followed for 1 year. Anti-platelet antibodies (APAs), TPO levels and indium-111 platelet scintigraphy were assessed before, during and after romiplostim. Censored survival analysis showed that the probability of SROT at 1 year after tapering was 23.6% (95% confidence interval: 11.0%–50.5%). Patients with SROT had higher platelet levels on romiplostim (median: 332.5 vs. 84.5 × 109/L) and lower romiplostim doses at the start of tapering (median: 1.0 vs. 4.5 μg/kg) compared to those with a non-sustained response (NSR). APAs were detected in 8/25 patients at baseline, of which 5 showed a substantial decrease during romiplostim. The indium-111 scan revealed an improved platelet survival at the start of tapering for 50% of patients with SROT (2/4, missing n = 1) versus none with an NSR (0/14, missing n = 3). Overall, the STIP study demonstrated a probability of SROT of 23.6% in a diverse and largely chronic group of adult patients with ITP.
AB - Sustained remissions off-treatment (SROTs) after tapering of thrombopoietin receptor agonists (TPO-RAs) have been reported in 15%–50% of patients with immune thrombocytopenia (ITP). The STIP (Stop TPO-Receptor Agonist in ITP Patients) study is a prospective trial aimed to investigate the clinical effects of romiplostim tapering. Adult patients (22/40) with ITP ≥3 months received romiplostim for 1 year, were tapered and followed for 1 year. Anti-platelet antibodies (APAs), TPO levels and indium-111 platelet scintigraphy were assessed before, during and after romiplostim. Censored survival analysis showed that the probability of SROT at 1 year after tapering was 23.6% (95% confidence interval: 11.0%–50.5%). Patients with SROT had higher platelet levels on romiplostim (median: 332.5 vs. 84.5 × 109/L) and lower romiplostim doses at the start of tapering (median: 1.0 vs. 4.5 μg/kg) compared to those with a non-sustained response (NSR). APAs were detected in 8/25 patients at baseline, of which 5 showed a substantial decrease during romiplostim. The indium-111 scan revealed an improved platelet survival at the start of tapering for 50% of patients with SROT (2/4, missing n = 1) versus none with an NSR (0/14, missing n = 3). Overall, the STIP study demonstrated a probability of SROT of 23.6% in a diverse and largely chronic group of adult patients with ITP.
KW - anti-platelet antibodies
KW - immune thrombocytopenia
KW - indium-111 platelet scintigraphy
KW - thrombopoietin receptor agonist
UR - http://www.scopus.com/inward/record.url?scp=105005572912&partnerID=8YFLogxK
U2 - 10.1111/bjh.20100
DO - 10.1111/bjh.20100
M3 - Article
C2 - 40384450
AN - SCOPUS:105005572912
SN - 0007-1048
VL - 206
SP - 1743
EP - 1753
JO - British Journal of Haematology
JF - British Journal of Haematology
IS - 6
ER -