Tapering and Discontinuation of Thrombopoietin Receptor Agonist Therapy in Patients with Immune Thrombocytopenia: Results from a Modified Delphi Panel

Acta Haematol. 2021;144(4):418-426. doi: 10.1159/000510676. Epub 2021 Mar 31.


Background: Recent evidence suggests that in patients with immune thrombocytopenia (ITP) with a stable response on thrombopoietin receptor agonists, treatment may be tapered and/or discontinued.

Objectives: The objective of this study was to provide a guide for tapering and discontinuation of TPO-RA therapy in patients with ITP, based on hematologist survey results, existing evidence, and expert consensus.

Patients/methods: UK hematologists completed a survey to characterize self-reported practice patterns related to TPO-RA tapering and discontinuation in patients with ITP. Using a modified Delphi panel approach, ITP experts developed consensus statements regarding the use of TPO-RA tapering and discontinuation.

Results: Survey respondents estimated that 30-34% of their patients were suitable for tapering or discontinuation and that 29-35% of these patients required treatment re-initiation after an average treatment-free interval of 86-106 days. No clear predictors of patient suitability or response to tapering or discontinuation were identified. The ITP expert consensus was that approximately 30% of patients are eligible for tapering and discontinuation, which may be considered after 6-12 months for patients demonstrating an adequate treatment response (platelet count >50,000/µL at ≥75% of assessments in the preceding 6 months). Treatment re-initiation may be considered if the platelet count decreases or if the patient becomes symptomatic. Individual differences need to be taken into account when considering TPO-RA tapering or discontinuation.

Conclusions: Tapering and discontinuation of TPO-RA therapy may be considered for certain patients with ITP. Further study is needed to better predict patients likely to achieve sustained off-treatment responses after tapering and discontinuation.

Keywords: Eltrombopag; Immune thrombocytopenia; Romiplostim; Thrombopoietin receptor agonists; Treatment discontinuation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Benzoates / therapeutic use
  • Humans
  • Hydrazines / therapeutic use
  • Medication Adherence
  • Physicians / psychology
  • Platelet Count
  • Purpura, Thrombocytopenic, Idiopathic / drug therapy*
  • Pyrazoles / therapeutic use
  • Receptors, Fc / therapeutic use
  • Receptors, Thrombopoietin / agonists*
  • Recombinant Fusion Proteins / therapeutic use
  • Recurrence
  • Remission Induction
  • Retreatment
  • Self Report
  • Surveys and Questionnaires
  • Thrombopoietin / therapeutic use


  • Benzoates
  • Hydrazines
  • Pyrazoles
  • Receptors, Fc
  • Receptors, Thrombopoietin
  • Recombinant Fusion Proteins
  • Thrombopoietin
  • romiplostim
  • eltrombopag