Is switching to romiplostim still worthwhile after failure of multiple oral TPO-RAs in pediatric refractory ITP?

Abstract Background: Thrombopoietin receptor agonists (TPO-RAs) are recommended second-line therapies for pediatric immune thrombocytopenia (ITP). If one agent proves ineffective, switching between TPO-RAs, particularly from oral agents such as eltrombopag (ELT) or avatrombopag (AVA) to the injectable romiplostim (ROM), has been suggested. However, it is unclear whether switching to ROM still provides meaningful benefit if multiple oral TPO-RAs have already failed. In China, the late marketing of ROM led to late use after failing oral TPO-RAs, providing a unique real-world scenario.