Presenting Authors: Ashley Jones, PharmD, BCOP; Hetalkumari Patel, PharmD, BCOP; Kailee Gaines, PharmD, BCOP, University of Texas Southwestern Medical Center, Dallas, TX
BACKGROUND: Romiplostim is a thrombopoietin (TPO) receptor agonist, which increases platelet counts by binding to and activating the human TPO receptor. This TPO receptor agonist is frequently used for the treatment of immune thrombocytopenia, chemotherapy-induced thrombocytopenia, and thrombocytopenia following hematopoietic stem-cell transplant or CAR-T therapy. The prescribing information recommends using the lowest dose sufficient to maintain platelet count ≥50,000 to reduce the risk for bleeding and contains standard dose-adjustment recommendations to achieve this. Our institution initiated an “opt-in” romiplostim pharmacist-driven dosing protocol in May 2025 to increase overall efficiency within our cancer center. Before initiation of the protocol, romiplostim dose adjustments were performed by the provider or pharmacist specialist, either before a patient’s infusion appointment or via pharmacist clarification with the provider on order release. Clarifications made after orders were released led to disruptions of the provider in clinic and potentially delayed administration due to the pharmacist awaiting provider response.
OBJECTIVE: To evaluate the time to verification of romiplostim orders using a pharmacist-driven lab evaluation and subsequent dose-adjustment protocol for romiplostim.
METHODS: We performed a retrospective chart review for patients receiving romiplostim 6 months following protocol implementation to evaluate the number of patients converted to pharmacist-driven dosing, the difference in verification time, and the number of doses adjusted by the provider before and following dose-adjustment protocol implementation.
RESULTS: From May to November 2025, a total of 370 doses of romiplostim were given, and of these, 131 (35.4%) were given per the dosing protocol. No significant reduction in time to order verification was observed between doses adjusted on and off protocol (13.3 minutes vs 13 minutes). However, we did note a reduction in doses adjusted by the provider for patients on protocol, with 55.2% and 33.3% of doses adjusted by the provider for patients off and on protocol, respectively.
CONCLUSION: The implementation of a pharmacist-driven romiplostim dosing protocol improved efficiency for our cancer center because it effectively shifted the workload of dose adjustment from the provider to the pharmacist. In addition, we identified numerous patients on long-term romiplostim initiated prior to the protocol implementation, representing possible missed opportunities. Although no difference in time to order verification was noted, we expect a potential reduction in chair time as more patients are transitioned to the protocol.
- Nplate (romiplostim) [prescribing information]. Amgen Inc; February 2022.
- Newland A, Godeau B, Priego V, et al. Remission and platelet responses with romiplostim in primary immune thrombocytopenia: final results from a phase 2 study. Br J Haematol. 2016;172:262-273.
- Promacta (eltrombopag) [prescribing information]. Novartis; June 2025.
- Neunert C, Terrell DR, Arnold DM, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019;3:3829-3866. doi:10.1182/bloodadvances.2019000966
- Kuter DJ, Bussel JB, Lyons RM, et al. Efficacy of romiplostim in patients with chronic immune thrombocytopenic purpura: a double-blind randomised controlled trial. Lancet. 2008;371:395-403. doi:org/10.1016/S0140-6736(08)60203
- Provan D, Arnold DM, Bussel JB, et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv. 2019;3:3780-3817. doi:10.1182/bloodadvances.2019000812
- Parameswaran R, Lunning M, Devlin MS, et al. Romiplostim for management of chemotherapy-induced thrombocytopenia. Support Care Cancer. 2014;22:1217-1222. doi:10.1007/s00520-013-2074-2