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Eltrombopag (EPAG) has been approved for the treatment of aplastic anemia and immune thrombocytopenia, and some patients require long-term treatment
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Long-term treatment can lead to iron depletion, which has been underestimated, due to polyvalent cation chelation
A research team conducted a retrospective study of patients treated at the NIH for aplastic anemia, myelodysplastic syndrome, and monolineage cytopenias, comparing patients treated with EPAG to a historical cohort of immunosuppressive therapy without EPAG.
Compare
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Patients receiving EPAG were compared with a historical cohort receiving immunosuppressive therapy without EPAG
Figure 1: Iron Depletion Simulates Relapse During Long-Term Eltrombopag Use
Figure 1: Iron Depletion Simulates Relapse During Long-Term Eltrombopag UseThey examined iron parameters, treatment duration, response assessments, relapse rates, and common demographic parameters
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The research team included 521 subjects with (n = 315) or without EPAG (n = 206) in 11 studies and followed up for many years (3.
Figure 2: Eltrombopag mobilizes unstable iron pools
Figure 2: Eltrombopag mobilizes unstable iron poolsThe findings showed that the duration of EPAG exposure was associated with a reduction in ferritin (p = 4 × 10-14), regardless of response, maximal dose, or degree of initial iron overload
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Clearance followed first-order kinetics with faster clearance (half-life 15.
Figure 3: Long-term treatment with Eltrombopag leads to iron deficiency
Figure 3: Long-term treatment with Eltrombopag leads to iron deficiencyThe study found that the risk of iron depletion was dependent on baseline ferritin and duration of treatment
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Baseline ferritin was not associated with bone marrow failure response to EPAG or risk of relapse, and iron clearance time was not associated with disease response
Overall, this study concludes that EPAG is effective at chelating iron throughout the body, comparable to clinically available chelators
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Long-term use can deplete the body's iron levels and eventually lead to iron-deficiency anemia
This study concludes that EPAG is effective at chelating iron throughout the body, comparable to clinically available chelators
Original source:
Original source:Young DJ, Fan X, Groarke EM, Patel B, Desmond R, Winkler T, Larochelle A, Calvo KR, Young NS, Dunbar CE.
Young DJ, Fan X, Groarke EM, Patel B, Desmond R, Winkler T, Larochelle A, Calvo KR, Young NS, Dunbar CE.
Long-term eltrombopag for bone marrow failure depletes iron.
Am J Hematol.
2022 Mar 21.
doi : 10.
1002/ajh.
26543.
Epub ahead of print.
PMID: 35312200.
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