Eltrombopag Combining Rituximab Versus Eltrombopag in the Management of Primary Immune Thrombocytopenia (ITP) in Adults
Eltrombopag Combining Rituximab Versus Eltrombopag in the Management of Primary Immune Thrombocytopenia (ITP) in Adults
This multicenter randomized, open-label study aimed to compare the efficacy and safety of
 eltrombopag combining rituximab with eltrombopag in China adult ITP patients .This study was
 be conducted in adult ITP patients who had not responded to or had relapsed after previous
 treatment of ITP, including first line therapy and /or splenectomy.
The primary objective of this study was to evaluate the efficacy and safety of eltrombopag
 combining rituximab treating previously treated ITP patients compared to eltrombopag. The
 secondary objective was to evaluate the efficacy of eltrombopag combining rituximab in ITP
 patients with positive autoantibody compared to eltrombopag .In addition, health-related
 quality of life (HRQoL) measure was assessed in all participants.

 224 eligible subjects were randomized to either eltrombopag combining rituximab or
 eltrombopag treatment in 1:1 ratio. 112 enrolled patients are randomly picked up to take
 eltrombopag combining with rituximab at the indicated dose. 112 enrolled patients are
 randomly picked up to take eltrombopag at the indicated dose.

 The initial dose of eltrombopag administration was an oral 75 mg once daily in all
 participants .The dose of eltrombopag was adjusted according to the subject platelet count
 during the period from week 1 to week 24.

 Subjects in eltrombopag combining rituximab treatment group received single dose infusion of
 rituximab 375 mg/m(2) within 14 days after enrollment.
Inclusion Criteria:

 1. Signed written informed consent

 2. Age from 18 to 60 years old

 3. Diagnosed with ITP and have a platelet count of <30 ×10^9/L on Day 1 (or within 48
 hours prior to dosing on Day 1).

 4. Patients who have no response or relapsed after splenectomy(at least more than 6
 months). Or patients who have not been splenectomised and have either not responded to
 one or more prior therapies, or who have relapsed prior therapy.

 5. Subjects treated with previous therapy(including but not limited to corticosteroid,
 azathioprine, danazol, cyclosporin A, mycophenolate mofetil) must have been completed
 prior to randomization, or must not be increasing a dose after enrollment.

 6. No pre-existing cardiac disease within the last 3 months. No arrhythmia known to
 increase the risk of thrombolic events (e.g. atrial fibrillation), or patients with a
 Corrected QT interval (QTc) >450msec or QTc >480 for patients with a Bundle Branch
 Block.

 7. No pre-existing infection within the last 1 months(including but not limited to
 pulmonary infection)

 8. Laboratory tests for coagulation function showed that prothrombin time (PT/INR) and
 activated partial thromboplastin time (APTT) no exceed normal by more than 20%. No
 history of clotting disorder, other than ITP.

 9. White blood cell count, neutrophil absolute value, hemoglobin, within the reference
 range, with the following exceptions:

 -  Hemoglobin: females and males 10.0 g/dl are eligible for inclusion,

 -  Absolute neutrophil count (ANC) ≥1500/µL (1.5×109/L) is required for inclusion

 10. The following blood chemistry test result no exceed normal by more than 20%:alanine
 aminotransferase, aspartate aminotransferase, total bilirubin, creatinine,serum
 albumin must not be below the lower limit of normal (LLN) by more than 10%.

 11. Subject is non-childbearing potential of childbearing potential and use acceptable
 methods of contraception throughout the study.

 12. Subjects fully understand and are able to comply with the requirements of the research
 protocol and are willing to complete the study as planned.

 Exclusion Criteria:

 1. Patients with any prior history of arterial or venous thrombosis, and with following
 risk factors: cancer, Factor V Leiden, ATIII deficiency, antiphospholipid syndrome.

 2. Pregnant or lactating women;

 3. Subjects is currently receiving treatment with another study medication.

 4. Any laboratory or clinical evidence for HIV infection.

 5. Any clinical history for hepatitis C infection; chronic hepatitis B infection; or any
 evidence for active hepatitis at the time of subject screening. Laboratory test shows
 positive serology for Hepatitis C or Hepatitis B (HB). In addition, if negative for
 HBsAg but HBcAb positive (regardless of HBsAb status), a HB DNA test will be performed
 and if positive the subject will be excluded.

 6. History of platelet aggregation that prevents reliable measurement of platelet counts.

 7. Any clinically relevant abnormality, other than ITP,which in the opinion of the
 investigator makes the subject unsuitable for participation in the study.