Applications and advances of the second generation of thrombopoietin receptor agonists

Thrombopoietin (TPO) is a major regulator of platelet production. The first generation of thrombocytopenia mimetics introduced a risk of antibody formation to endogenous TPO and then were discarded. Now the second-generation theombocytopenia mimetics thrombopoietin receptor agonist (TPORA) including romiplostim, ehrombopag and avatrombopag, could effectively and safely increase the platelet count of patients. At present, TPORA has been approved for the treatment of primary immune thrombocytopenia (ITP), severe aplastic anemia (SAA) and hepatitis C virus (HCV)-related chronic liver diseases. And there are a large number of clinical trials to study the safety and effectiveness of TPORA in other disease-related thrombocytopenia.The article reviews the literatures on the mechanisms and the current clinical use of TPORA and recent findings that may expand their clinical utilities Key words: Thrombocytopenia; Receptors, thrombopoietin; Second-generation; Romiplostim; Ehrombopag; Avatrombopag