PO0010 - Loss of response after discontinuation of eltrombopag in a patient with immune thrombocytopenia secondary to COVID-19: another finding of "persistent COVID syndrome"?

Background: Immune thrombocytopenia (IT) is a complication described within COVID-19, probably secondary to the "immunological storm" produced during the acute infection. It usually responds to first-line treatment (corticosteroids, immunoglobulins), with the use of thrombopoietin (TPO) agonists being somewhat infrequent.

Aims: The objective is to present these cases of eltrombopag-dependent immune thrombocytopenia secondary to severe COVID-19 infection within a probable context of "persistent COVID syndrome".

Methods: Unicentric, descriptive study that describes our experience with two patients who presented severe forms of COVID-19 (need to stay in intensive care) during the first wave (March 2020) and who to date have depended on eltrombopag to maintain hematological response.

Results: Two patients (women aged 67 and 65 years) with no relevant medical history, diagnosed in March and April 2020, respectively, with bibasal pneumonia secondary to severe COVID-19. On discharge they had severe IT associated with skin bleeding events, initially treated with oral prednisone mg/kg/day plus unspecific IVIg g/kg/day (no hematologic response in both cases) and dexamethasone 40 mg for 4 days plus unspecific IVIg g/kg/day every 15 days (3 cycles), without response. Second-line treatment was started with TPO analogues (oral eltrombopag 50 mg/day, with dose escalation to 75 mg/day), obtaining haematological response on day +7 of start and complete remission on day +21 of treatment. After 18 months of treatment at high doses, it was decided to de-escalate the dose, with loss of symptomatic hematological response, for which it was decided to return to the previous dose in both patients, with platelet count recovery 5-14 days later.

Conclusion(s): The fact that IT is refractory to corticosteroids and, furthermore, dependent on high doses of eltrombopag (with no possibility of reduction) after almost two years of treatment, gives us an idea that the process of immune dysregulation secondary to COVID -19 persists in time, as well as its long-term consequences.