Differences and usage comparison between avatrombopag and eltrombopag (Revlan)

Avatrombopag (Avatrombopag) and Eltrombopag (Eltrombopag ) are both thrombopoietic receptor agonists (TPO-RA) and are mainly used to treat thrombocytopenia, but they have certain differences in pharmacological effects, indications, administration methods and safety. Avatrombopag is an oral thrombopoietin receptor agonist that can directly act on the TPO receptor of bone marrow megakaryocytes, thereby promoting platelet production. Eltrombopag also works by activating TPO receptors, but its drug metabolism and drug interaction properties are slightly different. Neither is a hormonal drug, so long-term use does not cause hormone-related side effects, such as weight gain or osteoporosis.

In terms of indications, avatrombopag is mainly used in patients with chronic liver disease-related thrombocytopenia (CLD) and patients with chronic immune thrombocytopenia (ITP), while eltrombopag has a wider range of indications, including both adults and children. ITP, also includes patients with thrombocytopenia who have received a liver or bone marrow transplant. It is worth noting that for CLD patients, avatrombopag shows better tolerability and less liver toxicity, and therefore has more advantages in clinical application for liver disease-related thrombocytopenia. When eltrombopag is used in patients with impaired liver function, liver function indicators need to be carefully monitored. Some patients may experience elevated transaminases or elevated bilirubin.

In terms of administration method, both are oral drugs, but avatrombopag is less dependent on food and metal ions. Patients can take it with meals or on an empty stomach and is not affected by ions such as calcium, iron, and magnesium. When taking eltrombopag, attention should be paid to at least 2-4 hours between taking eltrombopag and foods or drugs containing calcium, iron, magnesium or aluminum to avoid affecting absorption, which affects the convenience of medication to a certain extent. In addition, avatrombopag can generally be administered once a day, while eltrombopag needs to be adjusted more frequently based on the patient's platelet level.

In terms of safety, both may cause platelets to rise too quickly or increase the risk of thrombosis, but clinical data show that avatrombopag has a relatively low risk of thrombosis in patients with liver disease and is less likely to cause liver enzyme abnormalities. Eltrombopag requires regular monitoring of platelets, liver function, and hematology indicators, especially during long-term use or high doses. Both treatments can effectively increase platelet counts and reduce bleeding events, but avatrombopag has a more stable effect in patients with liver disease, and it is easier to obtain patient compliance due to its high convenience in taking the drug.

Taken together, avatrombopag and eltrombopag are similar in mechanism, but have differences in indication selection, medication convenience and liver function tolerance. Clinically, appropriate drugs can be selected based on the patient's specific condition, basic liver function, lifestyle and medication compliance. Avatrombopag is suitable for patients with liver disease-related thrombocytopenia and who require a simple oral regimen, whereas eltrombopag is suitable for the broader thrombocytopenia group but requires more caution in dosing and monitoring. Reasonable selection of the two and individualized treatment plans are of great significance for improving efficacy, reducing risks and improving patients' quality of life.

Reference materials:https://www.nlm.nih.gov/