Thrombopoietin receptor agonists are safe and effective in children and adults with immune thrombocytopenia (ITP), according to a new meta-analysis published in Expert Opinion on Pharmacotherapy. The study also found that avatrombopag was more effective than eltrombopag and hetrombopag in adult patients based on overall platelet response rates.

The study authors concluded that thrombopoietin receptor agonists have “a broad application prospect in the treatment of ITP.”

To review the safety and efficacy of thrombopoietin receptor agonists in the treatment of persistent and chronic ITP in both children and adults, a team of researchers from China reviewed the results of randomized controlled trials of avatrombopag, hetrombopag, eltrombopag, and romiplostim.

Read more about the treatment of ITP

They included 1563 patients from 15 randomized controlled trials in their analysis. Of these, 10 were trials in adults and 5 were conducted in children. 

The results showed that adult patients treated with thrombopoietin receptor agonists had longer durations of platelet response and higher platelet response rates.

They also used less rescue therapy and had fewer bleeding events. Finally, the incidence of adverse events was similar to that seen in patients given a placebo during the clinical trials. 

Similar results were obtained in children with ITP treated with thrombopoietin receptor agonists, apart from the incidence of bleeding. 

ITP is a rare bleeding disorder characterized by very low platelet counts resulting in symptoms such as petechiae, purpura, ecchymoses, nosebleed, mucosal bleeding, hematuria, and increased menstrual bleeding.

The initial management of the disease involves avoiding bleeding triggers. First-line therapy includes corticosteroid therapy, to which most patients respond well. However, the risk of relapse is high.

Thrombopoietin receptor agonists have become the first choice of second-line treatment in patients for whom frontline treatment fails.


Li T, Liu Q, Pu T, et al. Efficacy and safety of thrombopoietin receptor agonists in children and adults with persistent and chronic immune thrombocytopenia: a meta-analysis. Expert Opin Pharmacother. Published online April 6, 2023. doi:10.1080/14656566.2023.2198089