A panel of experts consisting of immune thrombocytopenia (ITP) senior hematologists from 8 countries in Central Europe reached a consensus on 7 statements for the second-line use of thrombopoietin receptor agonists in the management of adults with the disease.

“This work will facilitate informed decision-making for healthcare providers treating adult ITP patients,” the researchers wrote.

Read more about ITP guidelines

The paper was published in the journal Annals of Hematology.

Currently, there are 3 thrombopoietin receptor agonists that are approved in Europe for the treatment of ITP. However, data about their clinical efficacy is limited, the researchers noted.

To clarify the relevance and strength of the evidence concerning the use of these medications in adult ITP patients, a team consisting of 8 ITP senior hematologists from Croatia, Slovakia, Hungary, Czech Republic, Romania, Bulgaria, Russia, and Poland performed a systematic review of the literature and identified 478 unique articles. Of these, they analyzed 40 that met the relevance criteria. These included 5 meta-analyses that analyzed all 3 treatments approved in Europe and 31 unique randomized controlled trials.

They also conducted 2 rounds of surveys, a teleconference, and email correspondence and reached a consensus.

The team also discussed thrombopoietin receptor agonists as first-line treatment for ITP and their use in patients with chronic ITP who had mild to moderate COVID-19 but could not reach a consensus.

They said that more studies are required on the use of these treatments in the first-line setting and in specific patient populations.

ITP is a rare autoimmune bleeding disorder with unusually low platelet count. Symptoms include petechiae, purpura, ecchymoses, nosebleed, mucosal bleeding, hematuria, and heavy menstrual bleeding. The first-line treatment of the disease includes corticosteroids and intravenous immunoglobulin, while the second-line treatment includes splenectomy, rituximab, and thrombopoietin receptor agonists.


Pulanić D, Bátorová A, Bodó I, et al. Use of thrombopoietin receptor agonists in adults with immune thrombocytopenia: a systematic review and Central European expert consensus. Ann Hematol. Published online February 24, 2023. doi:10.1007/s00277-023-05114-8