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Thus, the recommended starting dose is 25 mg once daily, and the maximal dose is restricted to 50 mg/d for East Asian patients. A recent Japanese trial evaluated the efficacy and safety of eltrombopag selleck inhibitor with a lower starting dose (12.5 mg daily) and a maximum dose of 50 mg daily for Japanese ITP patients [6]. In that study, 22% (5/23) of patients responded to 12.5 mg of eltrombopag during the first 3 weeks of treatment, indicating the lower starting dose of eltrombopag may be effective in Japanese ITP patients. Generally, to avoid an excessive increase in platelet counts, eltrombopag doses are carefully adjusted to maintain safe platelet counts. TPO receptor agonists, including eltrombopag, require continuous treatment to maintain the response. Notably, when TPO receptor agonists are abruptly discontinued, ITP recurs or is transiently worsened [7, 8]. In addition, adult ITP is usually a chronic disease, and the sensitivity to TPO receptor agonists may increase or decrease over time. Therefore, it is necessary to find an effective eltrombopag maintenance dose in every ITP patient. Recent evidence suggests the absence of cross-resistance between 2 available TPO receptor agonists, eltrombopag and romiplostim [9, 10, 11]. However, the majority of clinical evidence is from case reports with limited sample sizes. The reasons for this phenomenon are currently unknown; however, one study suggested that the absence of cross-resistance between the 2 drugs is likely due to their different mechanisms of action [12]. In this study, we attempted to determine Enzalutamide mouse an effective dose of eltrombopag to achieve and maintain safe platelet counts and to evaluate the safety of eltrombopag in Korean adult ITP patients. Furthermore, we also evaluated the possibility of sequential treatment with romiplostim in patients who experienced relapse or were resistant to eltrombopag treatment. MATERIALS AND METHODS Patients and treatment protocol Eighteen adult chronic ITP patients who were refractory to previous ITP treatments (platelet count Histone demethylase enrolled in the study. Eligible patients were 18 years or older and had ITP for more than 3 months (persistent or chronic phases according to the new definitions of ITP [13, 14]). All patients were diagnosed with primary ITP according to the current definitions [14, 15]. Bone marrow (BM) examinations, including reticulin, Masson-trichrome, and collagen staining, were performed, and it was confirmed that none of the patients had BM fibrosis before eltrombopag treatment. Follow-up BM examinations were performed after 1 year of eltrombopag treatment or at the time of eltrombopag discontinuation. BM fibrosis grading was determined by current guidelines [16]. Approval was obtained from the institutional review boards for this study. All patients gave informed consent for the treatment and data analysis.