The following is a summary of “Immune thrombocytopenia: Pathophysiology and impacts of Romiplostim treatment,” published in the June 2024 issue of Hematology by Semple et al.

Immune thrombocytopenia (ITP) represents a multifaceted autoimmune condition characterized by the immune system mistakenly targeting platelets, leading to their destruction and subsequent reduction in circulating platelet levels below 100 × 10⁹/L. This condition significantly heightens the risk of bleeding, ranging from mild bruising to severe hemorrhage, impacting patients’ daily lives and necessitating effective management strategies. The pathophysiology of ITP involves a breakdown in immune tolerance mechanisms, where autoantibodies, particularly against glycoproteins on platelet surfaces, trigger accelerated platelet clearance by macrophages in the spleen and liver. Concurrently, impaired megakaryocyte production further exacerbates thrombocytopenia, complicating the disease course.

Current therapeutic approaches for ITP are diverse and aim to elevate platelet counts to safe levels, thereby reducing bleeding risk and improving patients’ quality of life. Initial treatments often involve corticosteroids or intravenous immunoglobulins (IVIg) to suppress immune responses and temporarily increase platelet production. However, these treatments may not provide sustained benefits for all patients, leading to the consideration of second-line therapies such as rituximab and thrombopoietin receptor agonists (TPO-RAs).

Among TPO-RAs, Romiplostim stands out due to its ability to mimic the action of endogenous thrombopoietin, stimulating the maturation and proliferation of megakaryocytes in the bone marrow. By activating thrombopoietin receptors on megakaryocytes, Romiplostim effectively enhances platelet production, thereby addressing the underlying thrombocytopenia in ITP. Beyond its primary role in platelet regulation, recent research has unveiled additional immunomodulatory effects of Romiplostim, suggesting it may influence autoimmune processes beyond mere platelet production.

This comprehensive understanding underscores Romiplostim’s pivotal role in the management of ITP, offering a means to stabilize platelet levels and potentially modify the autoimmune response underlying the disease. By exploring these facets, this review contributes to a nuanced appreciation of how Romiplostim fits into the treatment landscape of ITP, highlighting its dual impact on platelet biology and autoimmune modulation. Thus, it informs clinical decisions aimed at optimizing outcomes for patients with this challenging hematological condition.

Source: sciencedirect.com/science/article/abs/pii/S0268960X24000559