Romiplostim

How it works

It binds and activates the thrombopoietin (TPO) receptor on megakaryocyte precursors, stimulating megakaryocyte proliferation and differentiation to increase platelet production.

Prescribing in practice

• The dose is titrated to the lowest level achieving a safe platelet count rather than a normal count, because excessive platelet rise increases thrombotic risk and abrupt withdrawal can cause rebound thrombocytopenia.
• Increased bone marrow reticulin has been reported with long-term use, which may require evaluation if blood film changes occur.
• It is given by subcutaneous injection once weekly with weekly dose adjustment guided by platelet count per the SPC.

Monitoring

Monitor weekly full blood counts including platelets and blood film during dose titration, then regularly once stable, watching for thrombosis and rebound thrombocytopenia after stopping.

Counselling the patient

• Explain that the dose is adjusted using weekly blood tests to keep platelets at a safe level.
• Advise not to stop treatment abruptly without medical advice and to report symptoms of clots or unusual bruising or bleeding.

Evidence & guidelines

Randomised trials and NICE guidance support romiplostim for chronic immune thrombocytopenia in adults.