Indication

Primary chronic immune thrombocytopenia

RAG rating

Red

Document type

Decision document

Place

Hertfordshire and West Essex ICB

Output type

Pharmacy / Prescribing

Document

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Avatrombopag

HERTFORDSHIRE AND WEST ESSEX AREA PRESCRIBING COMMITTEE (HWE APC)

Avatrombopag for the treatment of primary chronic immune thrombocytopenia

RED

Recommended for restricted prescribing by specialist only

Not recommended for primary care prescribing

Name generic (trade) Avatrombopag

What it is Thrombopoietin (TPO) receptor agonist

Indication for the treatment of primary chronic immune thrombocytopenia (ITP) in adult patients who are refractory to other treatments (e.g. corticosteroids, immunoglobulins)

Date decision last revised February 2023

Decision status Final

NICE / SMC Guidance NICE TA - 853 recommended

HWE APC recommendation

Avatrombopag is recommended, within its marketing authorisation, as an option for treating primary chronic immune thrombocytopenia (ITP) refractory to other treatments (for example, corticosteroids, immunoglobulins) in adults in line with the recommendations in NICE TA 853 and initiation criteria for TPO-RAs already agreed across HWE ICB:

• diagnosis of ITP >12 months duration and

• standard active therapies (including rituximab and immunosuppressants e.g. azathioprine, ciclosporin, mycophenolate) have failed to control bleeding requiring hospitalisation, or where patient is intolerant of these therapies

• platelet count <30x109 /L and requiring rescue treatments with IVIg

Discontinue if platelet count does not increase to ≥ 50 x 109 /L after 4 weeks at maximum dose of 40 mg once daily. Discontinue if platelet count is greater than 250 x 109 /L after 2 weeks of dosing at 20 mg once weekly.
Red status (specialist prescribing/monitoring).
National tariff excluded.
If avatrombopag is considered one of a number of suitable treatments, the least expensive (taking into account administration costs & patient access schemes) should be chosen.

NICE TA 853 recommendations: Avatrombopag is recommended, within its marketing authorisation, as an option for treating primary chronic immune thrombocytopenia (ITP) refractory to other treatments (for example, corticosteroids, immunoglobulins) in adults. It is only recommended if the company provides it according to the commercial arrangement

Review date: The recommendation is based upon the evidence available at the time of publication. This recommendation will be reviewed upon request in the light of new evidence becoming available