Romiplostim, a thrombopoietin-receptor agonist (TPO-ra), is a highly effective option in primary immune thrombocytopenia\n(ITP), with 80ââ?¬â??90% of patients achieving platelet responses after few weeks of treatment. The evidence showing remissions, that\nis, sustained platelet counts after romiplostim discontinuation, in patients with ITP refractory to immunosuppressive therapy is\nsteadily increasing. However, there is a lack of guidelines or recommendations addressing how and when to taper romiplostim\nin clinical practice in patients maintaining elevated and stable platelet counts. Furthermore, given the high heterogeneity of ITP\npatients, no associated predictive factors have been currently identified. Here, we present 4 representative clinical cases of the daily\nclinical practice in Spain comprising newly diagnosed, persistent, and both splenectomized and nonsplenectomized chronic ITP\npatients treated with romiplostim, achieving and maintaining clinical remission (platelet count ââ?°Â¥ 50 Ã?â?? 109/L for 24 consecutive\nweeks in the absence of any treatment for ITP) after treatment tapering and discontinuation, without observed safety concerns.\nProspective studies identifying clinical and biological predictive factors of sustained response are warranted.
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