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Comparison of starting doses of anagrelide as a first-line therapy in patients with cytoreductive therapy-naïve essential thrombocythemia: difference between starting at 0.5 and 1.0 mg/day

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Abstract

Anagrelide is widely used for cytoreductive therapy in patients with essential thrombocythemia who are at high risk for thrombosis. The recommended starting dose in the package insert of anagrelide varies by country. A high starting dose leads to an early onset of action, but causes a higher incidence of adverse events. This relationship indicates that both the onset of action and side effects of anagrelide are dose dependent. We retrospectively compared the efficacy and safety of anagrelide as a first-line drug between patients with essential thrombocythemia who started at 0.5 or 1.0 mg/day. Incidence of total adverse events and anagrelide-related palpitation, discontinuation rates, and the median daily dose of anagrelide were lower in the 0.5 mg/day group than in the 1.0 mg/day group; however, comparable platelet-lowering effects were achieved in both groups. These data suggest that a low starting dose of anagrelide followed by dose escalation may result in fewer adverse events and lower discontinuation rates, while providing desirable platelet-lowering effects. Initiating anagrelide at a lower dose may be a useful approach in actual clinical practice.

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Acknowledgements

We would like to express our sincere gratitude to Professor Norio Komatsu of the Department of Hematology, Juntendo University School of Medicine for the MPN gene mutation analysis of patients in Kansai Medical University Hospital. We also thank Joe Barber Jr., PhD, from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

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  1. Yoshinori Hashimoto and Tomoki Ito contributed equally to this work.

Authors and Affiliations

  1. Department of Hematology, Tottori Prefectural Central Hospital, Tottori, Tottori, Japan

    Yoshinori Hashimoto, Hiromi Omura & Takayuki Tanaka

  2. First Department of Internal Medicine, Kansai Medical University, 2-5-1, Shinmachi, Hirakata-City, Osaka, 573-1010, Japan

    Tomoki Ito, Aya Nakaya, Shinya Fujita, Atsushi Satake, Takahisa Nakanishi, Akiko Konishi, Masaaki Hotta, Hideaki Yoshimura, Kazuyoshi Ishii & Shosaku Nomura

  3. Department of Hematology and Clinical Immunology, Kobe City Nishi-Kobe Medical Center, Kobe, Hyogo, Japan

    Yasuhiro Tanaka, Akiko Hashimoto & Isaku Shinzato

  4. Department of Hematology, Kawasaki Medical School, Kurashiki, Okayama, Japan

    Toshinori Kondo

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Correspondence to Tomoki Ito.

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Tomoki Ito reports receiving honoraria from Takeda Pharmaceutical Co., Ltd. Yoshinori Hashimoto reports receiving honoraria from Shire Japan K.K. The other authors declare that they have no conflict of interest.

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Hashimoto, Y., Ito, T., Tanaka, Y. et al. Comparison of starting doses of anagrelide as a first-line therapy in patients with cytoreductive therapy-naïve essential thrombocythemia: difference between starting at 0.5 and 1.0 mg/day. Int J Hematol 112, 33–40 (2020). https://doi.org/10.1007/s12185-020-02876-z

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