Successful Treatment of Systemic Lupus Erythematosus-Associated Thrombocytopenia with Eltrombopag: A Report of Two Cases and Literature Review

Thrombocytopenia is one of the common haematological manifestations, occurring in 7% to 30% of systemic lupus erythematosus (SLE) patients. Immune thrombocytopenia (ITP) may occur in variable pathways as a result of cross-reacting antibodies or immune complexes that bind to platelet receptors, or infection of progenitor megakaryocytes, and decreased production of thrombopoietin (TPO). It was shown that the vast majority of SLE patients with thrombocytopenia had increased levels of anti-glycoprotein IIb/IIIa (anti-GPIIb/IIIa) or anti-thrombopoietin receptor (anti-TPOR). Eltrombopag is a thrombopoietin receptor agonist that binds to the transmembrane portion of the surface receptor and induces maturation of megakaryocytes and production of platelets. Herein, we report two SLE patients with severe thrombocytopenia who are also refractory to both intravenous immunoglobulin (IVIG), rituximab, and splenectomy. Ultimately, they successfully treated with eltrombopag without any complication. Eltrombopag worked well and their platelet counts increased above 200,000/mm3 only two weeks later.