English - the European Oncology Nursing Society

similar or worse compared with patients with diabetes or arthritis(19). Patients report that the bruising and bleeding resulting from ITPhas a substantial negative effect on their quality of life, and fatigue(possibly due to the anaemia caused by bleeding) hinders theirability to perform their routine daily activities. (20). When presentedwith a patient with ITP, the nurse therefore has to help the patientadapt to the physical and psychosocial demands of the disease. Thechanges to body image associated with corticosteroid treatment,the implications of a potential splenectomy, rehabilitation, roles andresponsibilities, and the risk of sepsis are examples of some of thefears and concerns that nurses should be assessing and addressingwhen informing patients about, and explaining, different treatmentoptions to patients with ITP. Keeping up to date with the developingand future therapeutic options enables the nurse to educate andreassure the patient, thereby potentially alleviating fears of treatmentfailure or that eventual splenectomy is unavoidable.The long-term efficacy and safety of romiplostim are now beingconfirmed in an ongoing, open-label, extension study (15). TheEuropean Medicines Evaluation Agency is currently reviewing theMarketing Authorisation Application for romiplostim. Romiplostimwas recently approved for the treatment of adults with chronic ITP inthe US and Australia.EltrombopagEltrombopag is a small molecule TPO receptor agonist that isadministered orally once-daily. It activates the TPO receptor bybinding to the transmembrane region. Although eltrombopag bindsto the receptor differently than endogenous TPO or romiplostim, thefinal pathways seem to be identical (4). The results from a 6-weektreatment-period, placebo-controlled phase II trial where the primaryend point was a platelet count of ≥50 x 10 9 /L on day 43 of treatmentshowed that 28%, 70%, and 81% of patients receiving, respectively,30 mg, 50 mg or 75 mg of eltrombopag daily achieved this endpoint(versus 11% in the placebo group). (16)When considering the management of the patient, two importantMild to moderate headache was the most commonly reported issues during the treatment of ITP arise: firstly, the need for treatmentadverse event followed by aspartate aminotransferase elevation, concordance and secondly, regular platelet count monitoring. A onceweeklysubcutaneous therapy such as romiplostim may facilitateconstipation, fatigue, and rash. Cataracts have been noted in bothpreclinical and clinical studies of eltrombopag, and elevated alanine concordance; it also combines treatment with frequent platelettransaminase in conjunction with raised bilirubin levels have been count monitoring and reinforces regular contact with medical staffobserved in some patients treated with eltrombopag (17). Phase III which may be reassuring for the patient. This approach facilitatesstudies of eltrombopag are currently ongoing and the published data individually tailored and controlled dosing schedules and minimisesare awaited soon.the risk of thrombosis that might occur if platelet counts increase(e.g. due to irregular drug intake).DiscussionWith the development of the TPO receptor agonists, the treatment In adults, ITP is a chronic disease often associated with a remittingoptions for patients with ITP have been widened. Current treatments – relapsing course. Many patients do not require treatment and thecan have many side effects and the treatment of ITP may result decision to introduce therapeutic interventions will be based uponin increased morbidity from adverse effects and opportunistic the laboratory findings, clinical circumstances, and individual patientinfections, which often surpass the problems actually caused by ITP risk factors. The development of the upcoming TPO receptor agonists(18). The phase III trials investigating romiplostim and the phase II provides patients with a new perspective to living with this chronictrials on eltrombopag show that TPO receptor agonists appear to be medical condition.well-tolerated and effective in patients with ITP (14, 16). As the TPOreceptor agonists are not immunosuppressive agents, the problems Acknowledgementsassociated with immunosuppressive treatment can be avoided and This article was supported by Amgen Europe GmbH, Zug, Switzerland.the overall health of the patient better maintained.Author for Correspondence: 033 Bevan House, Birmingham CityBoth the symptoms of ITP and its treatment affect the quality of life University, Edgbaston , Birmingham, B15 3TN, UK E-mail: dion.of the patient; indeed the impact on quality of life is perceived as smyth@bcu.ac.uk26 - newsletter fall 2008