埃尔特罗姆博帕格
医学
罗米普洛斯蒂姆
怀孕
血小板生成素
血小板生成素受体
耐火材料(行星科学)
血小板增多症
内科学
产科
儿科
血小板
免疫性血小板减少症
物理
造血
天体生物学
生物
遗传学
干细胞
作者
Marc Michel,Marco Ruggeri,Tomás José González-López,Salam Alkindi,Stéphane Chèze,Waleed Ghanima,Tor Henrik Anderson Tvedt,Mikaël Ebbo,Louis Terriou,James B. Bussel,Bertrand Godeau
出处
期刊:Blood
[American Society of Hematology]
日期:2020-12-24
卷期号:136 (26): 3056-3061
被引量:44
标识
DOI:10.1182/blood.2020007594
摘要
Abstract Management of immune thrombocytopenia (ITP) during pregnancy can be challenging because treatment choices are limited. Thrombopoietin receptor agonists (Tpo-RAs), which likely cross the placenta, are not recommended during pregnancy. To better assess the safety and efficacy of off-label use of Tpo-RAs during pregnancy, a multicenter observational and retrospective study was conducted. Results from 15 pregnant women with ITP (pregnancies, n = 17; neonates, n = 18) treated with either eltrombopag (n = 8) or romiplostim (n = 7) during pregnancy, including 2 patients with secondary ITP, were analyzed. Median time of Tpo-RA exposure during pregnancy was 4.4 weeks (range, 1-39 weeks); the indication for starting Tpo-RAs was preparation for delivery in 10 (58%) of 17 pregnancies, whereas 4 had chronic refractory symptomatic ITP and 3 were receiving eltrombopag when pregnancy started. Regarding safety, neither thromboembolic events among mothers nor Tpo-RA–related fetal or neonatal complications were observed, except for 1 case of neonatal thrombocytosis. Response to Tpo-RAs was achieved in 77% of cases, mostly in combination with concomitant ITP therapy (70% of responders). On the basis of these preliminary findings, temporary off-label use of Tpo-RAs for severe and/or refractory ITP during pregnancy seems safe for both mother and neonate and is likely to be helpful, especially before delivery.
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