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Masarova L, Verstovsek S. Emerging drugs for essential thrombocythemia. Expert Opin Emerg Drugs 2019; 24:93-105. [PMID: 31050912 DOI: 10.1080/14728214.2019.1615437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Despite our recent progress in the understanding of essential thrombocythemia (ET) pathogenesis, the therapeutic management of this disease has remained largely unchanged in the past decades. Treatment has mostly focused on decreasing the risk of complications, especially prevention of thrombotic or hemorrhagic events. Areas covered: Over recent years, the treatment options of ET have been expanding with some novel agents on the horizon. The classes of agents described in this review include targeted and immunomodulatory agents, such as JAK1/2 inhibitors, interferon-α, histone deacetylase inhibitors, telomerase inhibitors and human double minute 2 inhibitors. These compounds entered various stages of development, albeit the only portion of them is currently actively undergoing evaluation in clinical trials. In this review, we look at the current therapies and discuss novel agents available in the management of ET. Expert opinion: The drug development in ET possesses several challenges stemming from its relatively benign and prolonged disease course. Therapy focused on reducing the risk of thrombotic and hemorrhagic complications and symptom management needs to be chosen wisely as a vast majority of these patients have a near-normal life expectancy. To date, no therapy has shown effective and definitive alteration of the disease behavior. Although novel agents are in development and hopefully some of them will extend treatment armamentarium of ET, their exact role remains to be determined.
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Affiliation(s)
- Lucia Masarova
- a MD Anderson Cancer Center , The University of Texas , Houston , TX , USA
| | - Srdan Verstovsek
- a MD Anderson Cancer Center , The University of Texas , Houston , TX , USA
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Gisslinger H, Buxhofer-Ausch V, Hodisch J, Radinoff A, Karyagina E, Kyrcz-Krzemień S, Abdulkadyrov K, Gerbutavicius R, Melikyan A, Burgstaller S, Hus M, Kłoczko J, Yablokova V, Tzvetkov N, Całbecka M, Shneyder T, Warzocha K, Jurgutis M, Kaplanov K, Jilma B, Schoergenhofer C, Klade C. A phase III randomized, multicentre, double blind, active controlled trial to compare the efficacy and safety of two different anagrelide formulations in patients with essential thrombocythaemia - the TEAM-ET 2·0 trial. Br J Haematol 2019; 185:691-700. [PMID: 30919941 PMCID: PMC6594023 DOI: 10.1111/bjh.15824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/18/2018] [Indexed: 01/02/2023]
Abstract
Anagrelide is an established treatment option for essential thrombocythaemia (ET). A prolonged release formulation was developed with the aim of reducing dosing frequency and improving tolerability, without diminishing efficacy. This multicentre, randomized, double blind, active‐controlled, non‐inferiority trial investigated the efficacy, safety and tolerability of anagrelide prolonged release (A‐PR) over a reference product in high‐risk ET patients, either anagrelide‐naïve or ‐experienced. In a 6 to 12‐week titration period the individual dose for the consecutive 4‐week maintenance period was identified. The primary endpoint was the mean platelet count during the maintenance period (3 consecutive measurements, day 0, 14, 28). Of 112 included patients 106 were randomized. The mean screening platelet counts were 822 × 109/l (95% confidence interval (CI) 707–936 × 109/l) and 797 × 109/l (95% CI 708–883 × 109/l) for A‐PR and the reference product, respectively. Both treatments effectively reduced platelet counts, to mean 281 × 109/l for A‐PR (95% CI 254–311) and 305 × 109/l (95% CI 276–337) for the reference product (P < 0·0001, for non‐inferiority). Safety and tolerability were comparable between both drugs. The novel prolonged‐release formulation was equally effective and well tolerated compared to the reference product. A‐PR provides a more convenient dosing schedule and will offer an alternative to licensed immediate‐release anagrelide formulations.
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Affiliation(s)
- Heinz Gisslinger
- Department of Haematology and Blood Coagulation, Medical University of Vienna, Vienna, Austria
| | | | | | - Atanas Radinoff
- Clinic of Oncology and Haematology, Tokuda Hospital Sofia, Sofia, Bulgaria
| | | | - Slawomira Kyrcz-Krzemień
- Samodzielny Publiczny Szpital Kliniczny im, Andrzeja Mielęckiego Śląskiego Uniwersytetu Medycznego w Katowicach, Katowice, Poland
| | - Kudrat Abdulkadyrov
- Russian Scientific-Research Institute for Haematology and Transfusiology, St. Petersburg, Russian Federation
| | | | | | - Sonja Burgstaller
- Abteilung für Innere Medizin IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Marek Hus
- Klinika Hematoonkologii i Transplantacji Szpiku, Lublin, Poland
| | - Janusz Kłoczko
- Klinika Hematologii z Pododziałem Chorób Naczyń, Uniwersytecki Szpital Kliniczny w Białymstoku, Białystok, Poland
| | - Vera Yablokova
- Yaroslavl Regional Clinical Hospital, Yaroslavl, Russian Federation
| | - Nikolay Tzvetkov
- MHAT Dr. Georgi Stranski, Clinic of Haematology, Pleven, Bulgaria
| | - Malgorzata Całbecka
- Oddział Hematologii, Specjalistyczny Szpital Miejski im. M. Kopernika w Toruniu, Torun, Poland
| | - Tatyana Shneyder
- Leningrad Regional Clinical Hospital, St. Petersburg, Russian Federation
| | | | | | - Kamil Kaplanov
- Volgograd Regional Clinical Oncology Dispensary, Volgograd, Russian Federation
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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