You may be wondering about your immune thrombocytopenia (ITP) treatment options if your current medication no longer works as well as it once did. If first-line treatments, such as steroids, are no longer keeping your platelet counts at a safe level, your doctor may recommend trying a thrombopoietin receptor agonist, or TPO-RA.

TPO-RAs can help raise your platelet counts. This helps lower your risk of bleeding and may improve your quality of life. This article will cover when TPO-RAs are used, how they work, and what you can expect if your doctor recommends one.

When Are TPO Receptor Agonists Used?

You may not need a TPO-RA when you’re first diagnosed with ITP. Most people are first treated with corticosteroids, such as prednisone or dexamethasone. Steroids suppress immune system activity and reduce platelet destruction.

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IVIG (intravenous immune globulin) may also be used to increase platelets. Although these treatments do raise platelet counts, the effects of steroids and IVIG can be temporary. Platelet counts can fall again after treatment ends, especially in people with chronic ITP.

If this happens, your doctor may recommend another treatment option, often called a second-line treatment, such as TPO-RAs.

TPO-RAs are only one of several second-line treatment options available. They work by helping your body make more platelets.

They don’t cause long-term immunosuppression and aren’t permanent like surgery. Because of this, many doctors consider TPO-RAs an effective long-term treatment option for people with chronic ITP.

How Do TPO Receptor Agonists Work?

Thrombopoietin (TPO) is a hormone that your body naturally makes. This hormone tells megakaryocytes — the cells in your bone marrow — to make platelets. TPO-RA medications act like the hormone thrombopoietin.

TPO-RAs attach to receptors on megakaryocytes to signal your body to make more platelets. Multiple cell signaling pathways can be activated to help megakaryocytes grow, mature, and continue making platelets.

Unlike rituximab or corticosteroids, TPO-RAs don’t stop your immune system from attacking platelets. Instead, they help your body to simply make more platelets to keep up with the loss. For many people with chronic ITP, this helps keep their platelets at a safe level.

Benefits of TPO Receptor Agonists

The main goal of ITP treatment isn’t a normal platelet count. Rather, the goal is to help keep your platelet counts high enough to lower your bleeding risk. It’s also important to optimize your quality of life so you can continue your daily activities with confidence.

Many people on TPO-RAs have improvement in their ITP, such as:

• Higher platelet counts
• Fewer nosebleeds or gum bleeding
• Fewer petechiae (red or purple dots on your lower legs that look like a rash)
• Less bruising
• Less fatigue

When TPO-RAs can keep platelet counts in a safe range, many people are able to spend less time worrying about their bleeding risk during everyday activities. TPO-RAs can also reduce the need for rescue therapies, and some people may even be able to stop their steroids while on TPO-RAs.

Why Is Monitoring Important?

Regular blood tests help your doctor adjust your TPO-RA safely. Regular monitoring may include:

• Complete blood counts to check your platelet counts
• Liver function tests, for people who take eltrombopag
• Eye exams and monitoring for signs of cataracts, for people who take eltrombopag
• Routine follow-up appointments

Your doctor may increase or decrease your medication dose depending on your platelet count. The goal is to find the lowest dose that keeps your platelet count in a safe range.

Can You Stay on a TPO Receptor Agonist Long Term?

TPO-RAs can be used as long-term treatments, but not everyone needs to stay on them forever. Some people who have had stable platelet counts for a while may be able to slowly lower their dose and eventually stop treatment with their doctor’s guidance.

One study found that some people can maintain an adequate platelet response for 24 weeks after carefully tapering and stopping eltrombopag. A few small studies have shown that some people are able to safely taper off of TPO-RAs and their platelet counts remain stable, although many people will need to continue treatment.

There’s no one-size-fits-all approach that works for everyone. Treatment should be personalized based on your symptoms, platelet counts, medical history, and goals.

Choosing the right treatment is a decision that’s shared between you and your doctor. By understanding how TPO-RAs work, their benefits and side effects, and the differences between the available options, you can play an active role in creating a treatment plan that works for you.

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On myITPteam, people share their experiences with ITP, get advice, and find support from others who understand.

Have you tried a TPO receptor agonist? Has it improved your symptoms of ITP? Let others know in the comments below.