Galician-Asturian experience of avatrombopag use in immune thrombocytopenia

Background: Avatrombopag, a second-generation thrombopoietin receptor agonist (TPO-RA), has been approved to treat chronic immune thrombocytopenia (ITP) in adults and in patients with chronic liver disease before surgery. Introduced in the pharmacotherapeutic guide of hospitals in Galicia and Asturias (Spain) in 2023, this medication offers an option for patients who do not adequately respond to other treatments. Objective and method: This retrospective observational study evaluates the efficacy of avatrombopag in 55 patients with ITP, focusing on those treated in hospitals in Galicia and Asturias over 18 months. Of these, 53 had persistent/chronic ITP, and the majority were middle-aged women with a mean age of 64.7 years. Most patients (85.45%) had primary ITP and used avatrombopag as second or third-line treatment. Results: 94.45% of patients achieved a sustained response with a platelet count greater than 30 × 109/L. Additionally, a rapid response to avatrombopag was observed, with a median time to response of only 7 days. Despite some cases of serious adverse effects such as suspected medullary fibrosis and thromboembolism, overall tolerance to the medication was good. Conclusions: The study highlights the importance of customizing treatment according to individual patient characteristics and considering factors such as age and comorbidity. With an individualized approach, avatrombopag emerges as an effective and safe option for managing chronic ITP, offering a promising alternative to conventional therapies.