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Use of a Thrombopoietin Mimetic for Chronic Immune Thrombocytopenic Purpura in Pregnancy

Patil, Avinash S. MD; Dotters-Katz, Sarah K. MD; Metjian, Ara D. MD; James, Andra H. MD, MPH; Swamy, Geeta K. MD

doi: 10.1097/AOG.0b013e31828d5b56
Case Report

BACKGROUND: Romiplostim, a thrombopoietin mimetic, is a novel therapeutic option for patients with chronic immune thrombocytopenic purpura. We report on the effects of romiplostim use throughout pregnancy.

CASE: A 28-year-old primigravid woman with chronic immune thrombocytopenic purpura initiated a planned pregnancy on romiplostim. The second and third trimesters were marked by a cyclic pattern of thrombocytopenia requiring supplemental corticosteroids or intravenous immunoglobulin and resultant thrombocytosis. Increased romiplostim doses and daily corticosteroids stabilized the platelet count before induction of labor at 33 weeks of gestation. The newborn manifested intraventricular hemorrhage at birth, although no developmental delay was present on follow-up at 10 months of age.

CONCLUSION: The decreased efficacy of romiplostim monotherapy is attributed to increased target-mediated drug disposition and the physiologic changes of pregnancy. Safety concerns still exist for the developmental effects of romiplostim on the fetus.

Romiplostim, a thrombopoietin mimetic, has possible fetal effects and is not sufficient monotherapy for the treatment of chronic immune thrombocytopenic purpura in pregnancy.

Departments of Obstetrics & Gynecology and Medicine, Duke University Medical Center, Durham, North Carolina; and the Department of Obstetrics & Gynecology, University of Virginia, Charlottesville, Virginia.

Corresponding author: Avinash S. Patil, MD, DUMC Box 3967, Durham, NC 27710; e-mail: avi.s.patil@gmail.com.

Dr. Patil is supported by grant number 232GM086330 from The National Institute of General Medical Sciences for work in clinical pharmacology.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists.