WARNING: RISK FOR HEPATIC DECOMPENSATION IN PATIENTS WITH CHRONIC HEPATITIS C - In patients with chronic hepatitis C, PROMACTA in combination with interferon and ribavirin may increase the risk of...+
ASH Guidelines and the Treatment of ITP
Daniel Landau, MD, hematologist/oncologist, reviews the 2019 updates to the ASH guidelines for the treatment of ITP, including guidance on ITP treatment in first line, the importance of shared decision making in second line, and the long-term benefit PROMACTA® (eltrombopag) may offer patients with persistent or chronic ITP in second line.1,2
Treating ITP Through Telemedicine
Steven Fein, MD, hematologist, shares his experience as a telehealth provider and his approach to treating his patient, Daniel. He talks about Daniel’s ITP treatment journey, the importance of shared decision making when evaluating treatment options in second line, and the reasons why he recommended PROMACTA.1,2
Shared Decision Making in Chronic ITP
Daniel Landau, MD, hematologist/oncologist, discusses the ITP treatment journey of his patient, David, who struggled with fatigue that held him back from coaching his kids’ activities. He talks about the ITP treatment options in second line he shared with David, and considerations regarding David’s goals and treatment preferences, that led to their shared decision on PROMACTA.1,2
Oral Treatment for Adult Patients
Kristi Orbaugh, NP, adult oncology, talks about her patient, Maria, and Maria’s ITP treatment journey. When the ITP therapy Maria was taking became a burden for her, they talked with Maria’s hematologist and determined PROMACTA was the best option for Maria.1
Treatment That Travels With Your Patients
Kennon McCollum, DNP, Georgia Cancer Institute, talks about his patient, Ted. After hearing Ted’s case history and gaining an understanding of his lifestyle, McCollum decided to prescribe PROMACTA.1 In this video, he explains why he made that decision.
Treatment That May Help Reduce Bleeding Risk
Carl Chakmakjian, DO, oncologist, describes what led him to prescribe PROMACTA for his patient, Andrew. He talks about Andrew’s active lifestyle and how this, coupled with his understanding of Andrew’s case history, led him to prescribe PROMACTA.1
Managing Persistent or Chronic ITP After Treatment Failure
Morey Blinder, MD, a professor of medicine in the Division of Hematology at Washington University in St Louis, shares how he helps manage ITP for his patient, Michelle, who values traveling. He discusses the advantages of PROMACTA as a second-line treatment option and why he considered PROMACTA a good choice for Michelle.1
See how nonimmunosuppressive PROMACTA works synergistically with the body’s endogenous TPO.1,3
ASH, American Society of Hematology; ITP, immune thrombocytopenia; MOA, mechanism of action; TPO, thrombopoietin.
- Promacta [prescribing information]. East Hanover, NJ: Novartis Pharmaceuticals Corp; 2021.
- Neunert C, Terrell DR, Arnold DM, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019;3(23):3829-3866.
- Lum SH, Grainger JD. Eltrombopag for the treatment of aplastic anemia: current perspectives. Drug Des Devel Ther. 2016;10:2833-2843.
Indication and Important Safety Information
Indication for PROMACTA® (eltrombopag)
PROMACTA is indicated for the treatment of thrombocytopenia in adult and pediatric patients 1 year and older with persistent or chronic immune thrombocytopenia (ITP) who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy. PROMACTA should be used only in patients with ITP whose degree of thrombocytopenia and clinical condition increase the risk for bleeding.
Limitations of Use
PROMACTA is not indicated for the treatment of patients with myelodysplastic syndromes (MDS).
Safety and efficacy have not been established in combination with direct-acting antiviral agents used without interferon for treatment of chronic hepatitis C infection.
Important Safety Information for PROMACTA® (eltrombopag)
PROMACTA may increase the risk of severe and potentially life-threatening hepatotoxicity.
Treatment of ITP, chronic hepatitis C, and refractory severe aplastic anemia
- Measure serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin prior to initiation of PROMACTA, every 2 weeks during the dose-adjustment phase, and monthly following establishment of a stable dose
- PROMACTA inhibits UGT1A1 and OATP1B1, which may lead to indirect hyperbilirubinemia. If bilirubin is elevated, perform fractionation
- Evaluate abnormal serum liver tests with repeat testing within 3 to 5 days. If the abnormalities are confirmed, monitor serum liver tests weekly until resolved or stabilized
- Discontinue PROMACTA if ALT levels increase to ≥3 times the upper limit of normal in patients with normal liver function or ≥3 times baseline in patients with pretreatment elevations in transaminases and are progressively increasing; or persistent for ≥4 weeks; or accompanied by increased direct bilirubin; or accompanied by clinical symptoms of liver injury or evidence for hepatic decompensation
- If the potential benefit for reinitiating treatment with PROMACTA outweighs the risk for hepatotoxicity, then consider cautiously reintroducing PROMACTA and measure serum liver tests weekly during the dose-adjustment phase. Hepatotoxicity may reoccur if PROMACTA is reinitiated. If liver test abnormalities persist, worsen, or recur, then permanently discontinue PROMACTA
- Thrombotic/thromboembolic complications may result from increases in platelet counts with PROMACTA
- Reported thrombotic/thromboembolic complications included both venous and arterial events, and were observed at low and at normal platelet counts
- Portal vein thrombosis has been reported in patients with chronic liver disease receiving PROMACTA
- To minimize the risk for thrombotic/thromboembolic complications, do not use PROMACTA in an attempt to normalize platelet counts. Follow the dose-adjustment guidelines to achieve and maintain target platelet counts
Increased Risk of Death and Progression of Myelodysplastic Syndromes (MDS) to Acute Myeloid Leukemia (AML)
- In a clinical trial of patients with intermediate- to high-risk MDS and thrombocytopenia receiving PROMACTA, an increased number of progressions from MDS to AML and deaths have been observed compared to placebo
- PROMACTA is not indicated for the treatment of patients with MDS
- Development or worsening of cataracts with PROMACTA has been reported with a frequency of 5% to 11% in 6 clinical studies
- Perform a baseline ocular examination prior to initiating PROMACTA. Regularly monitor patients for signs and symptoms of cataracts while on PROMACTA
- Monitor serum liver tests
- During therapy with PROMACTA, assess complete blood counts (CBCs) with differentials, including platelet counts, weekly until a stable platelet count has been achieved. Monitor platelet counts monthly thereafter
- Obtain CBCs with differentials, including platelet counts, weekly for at least 4 weeks following discontinuation of PROMACTA
- When switching between the oral suspension and tablet, assess platelet counts weekly for 2 weeks, then follow standard monthly monitoring
Drug/Drug and Drug/Food Interactions
- PROMACTA must be taken at least 2 hours before or 4 hours after any medications or products containing polyvalent cations such as antacids, calcium-rich foods, and mineral supplements
- Take PROMACTA without a meal or with a meal low in calcium (≤50 mg)
Across all indications, the most common adverse reactions (≥20% in any indication) were anemia, nausea, pyrexia, ALT increased, cough, fatigue, headache, and diarrhea.
The most common adverse reactions in 3 placebo-controlled clinical trials in patients with persistent or chronic ITP (≥3% and greater than placebo) for PROMACTA were nausea (9%), diarrhea (9%), upper respiratory tract infection (7%), vomiting (6%), increased ALT (5%), myalgia (5%), urinary tract infection (5%), oropharyngeal pain (4%), increased AST (4%), pharyngitis (4%), back pain (3%), influenza (3%), paresthesia (3%), and rash (3%).
The most common adverse reactions in 2 placebo-controlled clinical trials in patients with persistent or chronic ITP 1 year and older (≥3% and greater than placebo) for PROMACTA were upper respiratory tract infection (17%), nasopharyngitis (12%), cough (9%), diarrhea (9%), pyrexia (9%), abdominal pain (8%), oropharyngeal pain (8%), toothache (6%), ALT increased (6%), rash (5%), AST increased (4%), and rhinorrhea (4%).