Clinical Impact of Eltrombopag-Associated Iron Chelation in Adults with Immune Thrombocytopenia: A Multicenter Real-World Study

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Yigitbasi A., ÜMİT E. G., DEMİRCİ U., AYGÜN G., Varli N., Aksoy E., ...Daha Fazla

MEDITERRANEAN JOURNAL OF HEMATOLOGY AND INFECTIOUS DISEASES, cilt.18, sa.1, 2026 (SCI-Expanded, Scopus)

Özet

Background: Eltrombopag (ELT) is an established thrombopoietin receptor agonist (TPO-RA) for chronic immune thrombocytopenia (ITP), yet accumulating translational evidence indicates clinically relevant iron-chelating activity. Adult primary ITP-focused data characterizing longitudinal iron trajectories during ELT remain limited. We assessed whether ELT exposure is independently associated with iron deficiency (ID) in routine practice. Methods: In this multicenter retrospective study, adults with ITP were evaluated with longitudinal monitoring of platelet count, ferritin, transferrin saturation (Tsat), hemoglobin (Hb), and mean platelet volume (MPV). Within-patient change was defined as the difference between baseline and follow-up (A). Outcomes were compared by ELT exposure and dose strata. Multivariable linear regression was used to identify independent determinants of A-ferritin, adjusting for age, gender, relapse status, and iron replacement therapy (IRT). Results: The cohort included 283 adults with ITP; 110 received ELT (median 25 months). ELT was associated with greater declines in ferritin and Tsat (p<0.001), with a dose-graded effect across 25-75 mg and earlier iron depletion at higher dose intensity. In relapsed patients not receiving ELT, the mean A-ferritin was positive and did not differ by bleeding status. In multivariable linear regression, ELT was the dominant independent predictor of lower A-ferritin (B approximate to-79.8 & micro;g/L, p<0.001), whereas age, gender, and relapse were not significant; IRT attenuated ferritin decline but did not negate ELT effects. Conclusion: ELT exposure was independently associated with ID, supporting a clinically meaningful ELT-related iron chelation phenotype in routine practice. Monitoring and timely correction of ID during ELT therapy may mitigate a modifiable contributor to fatigue during follow-up.