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Immune ThrombocytopeniaPhase 3NCT03939637

Eltrombopag vs Standard Front Line Management for Newly Diagnosed Immune Thrombocytopenia (ITP) in Children

A Phase 3 study testing Eltrombopag, Steroids and IVIG in people with Immune Thrombocytopenia, run by Baylor College of Medicine at 27 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
Search all trials

Trial summary

This is an investigator initiated, multicenter, open label, randomized phase 3 study for subjects with newly diagnosed ITP from ages 1 to less than 18 years old. Read more about this study

Who is it for?
Ages 1 year to 18 years
Conditions the study is for
Immune Thrombocytopenia
What is being tested?
Eltrombopag, Steroids and IVIG
Could I receive a placebo?
No, everyone receives an active treatment
How many people
122 participants
Where
27 sitesUnited States
Study dates
2 May 2019to 26 Feb 2025
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 1 year to 18 years
  • All sexes
  • No healthy volunteers
  • Child, Adult

Who may be able to join

  • Age: 1- <18 years
  • Newly diagnosed ITP (<3 months from diagnosis (first abnormal platelet count), per international working group definition17)
  • Platelets <30 x 10^9/L at screening
  • Requires pharmacologic treatment from the perspective of the treating clinician.
  • Need to treat is at the discretion of the investigator, but there should be clinical equipoise about the use of eltrombopag vs standard treatment options (patients should not, in the opinion of the investigator, require concomitant therapy at time of enrollment).
  • Treatment options include one of three standard therapies, (IVIg, steroids, or Anti-D). For example, if patient has previously shown no response to IVIg or steroids and is Rh-negative, patient would not be eligible for study.
Show all 13Show fewer
  • Patient population includes both:
  • Upfront treatment: Patient within 10 days of ITP diagnosis who has not received previous treatment OR
  • Treatment failure: Patients who have failed standard management (observation or treatment with one or more first-line agents)
  • Failure of observation: no platelet recovery (>30 x 10^9/L) with observation >10 days from diagnosis, with need to treat
  • Poor response to first-line agent (platelets remain <30 x10^9/L)
  • Initial response to first-line agent, but response wanes and platelets fall below 30 x10^9/L
  • Family willing and able to return for required lab studies

Who cannot join

  • Severe bleeding: Buchanan Overall Grade 4 or 5 bleeding, or severe bleeding requiring emergent treatment at the discretion of the provider. (e.g., intracranial hemorrhage, pulmonary hemorrhage, bleeding with ongoing need for pRBC transfusion)
  • Prior treatment with TPO-RA (eltrombopag or romiplostim)
  • Known secondary ITP (due to lupus, CVID, ALPS)
  • Known HIV (or history of HIV positivity) or Hepatitis C (screening not required if no clinical suspicion)
  • Evans Syndrome: positive direct Coombs with evidence of active hemolysis (elevated lactate dehydrogenase (LDH) or reticulocyte count not attributable to recent treatment or bleeding)
  • Any Malignancy
Show all 38Show fewer
  • History of stem cell transplant or solid organ transplant
  • aspartate aminotransferase (AST) or ALT >2 x upper limit of normal (ULN)
  • Total bilirubin >1.5 × ULN
  • Subjects with liver cirrhosis (as determined by the investigator)
  • Creatinine >2.5 × ULN
  • Known active or uncontrolled infections not responding to appropriate therapy
  • On anticoagulation or anti-platelet agents
  • Known thrombophilic risk factors. Exception: Subjects for whom the potential benefits of participating in the study outweigh the potential risks of thromboembolic events, as determined by the investigator.
  • Baseline ophthalmic problems that may potentiate cataract development
  • Impaired cardiac function, such as:
  • Known prolonged QTc, with corrected QTc >450 msec
  • Other clinically significant cardio-vascular disease (e.g., uncontrolled hypertension, history of labile hypertension),
  • History of known structural abnormalities (e.g. cardiomyopathy).
  • History or current diagnosis of cardiac disease indicating significant risk of safety for patients participating in the study such as uncontrolled or significant cardiac disease, including any of the following:
  • Recent myocardial infarction (within last 6 months),
  • Uncontrolled congestive heart failure,
  • Unstable angina (within last 6 months),
  • Clinically significant (symptomatic) cardiac arrhythmias (e.g., sustained ventricular tachycardia, and clinically significant second or third degree AV block without a pacemaker.)
  • Long QT syndrome, family history of idiopathic sudden death, congenital long QT syndrome or additional risk factors for cardiac repolarization abnormality, as determined by the investigator.
  • Known immediate or delayed hypersensitivity reaction to eltrombopag or its excipient.
  • Pregnant, breastfeeding, or unwilling to practice birth control during participation in the study. Women of childbearing potential (have achieved menarche) must have a negative serum or urine pregnancy test and agree to use basic methods of contraception (if sexually active) or maintain abstinence for the duration of the study. Basic contraception methods include:
  • Total abstinence (when this is in line with the preferred and usual lifestyle of the subject. Periodic abstinence (e.g., calendar, ovulation, symptothermal, post-ovulation methods) and withdrawal are not acceptable methods of contraception
  • Female sterilization (have had surgical bilateral oophorectomy with or without hysterectomy), total hysterectomy, or tubal ligation at least six weeks before taking study treatment. In case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow up hormone level assessment
  • Male sterilization (at least 6 months prior to screening). The vasectomized male partner should be the sole partner for that subject
  • Barrier methods of contraception: Condom or Occlusive cap. For the UK: with spermicidal foam/gel/film/cream/ vaginal suppository
  • Use of oral, injected or implanted hormonal methods of contraception or placement of an intrauterine device (IUD) or intrauterine system (IUS), or other forms of hormonal contraception that have comparable efficacy (failure rate <1%), for example hormone vaginal ring or transdermal hormone contraception. In case of use of oral contraception women should have been stable on the same pill for a minimum of 3 months before taking study treatment.
  • Male patients who are sexually active and do not agree to abstinence or to use a condom during intercourse while taking eltrombopag, and for 7 days after stopping treatment.
  • History of alcohol/drug abuse
  • Presence of a medical condition that in the opinion of the Investigator would compromise the safety of the patient or the quality of the data.
  • Concurrent participation in an investigational study within 30 days prior to enrollment or within 5-half-lives of the investigational product, whichever is longer. Note: parallel enrollment in a non-therapeutic trial such as disease registry or biology study is permitted.
  • Other Eligibility Criteria Considerations All patients and/or their parents or legal guardians must sign a written informed consent (and assent when applicable)
  • Patients and/or parents who are unable to read at a grade 2 level will be excluded from the patient-reported outcome component of the study, as will non-English speaking patients and/or parents when there is no availability of translated versions in their spoken language . They will not be excluded from all other aspects of the study

Trial locations and contacts

27 sites in 1 country.

27 sites in 1 country

United States27 sites
  • Alfac Cancer and Blood Disorder Center: Scottish Rite

    Atlanta, Georgia, 30342

  • Children's Hospital Colorado

    Aurora, Colorado, 80045

  • Children's of Alabama

    Birmingham, Alabama, 35233

  • Boston Children's Hospital

    Boston, Massachusetts, 02115

  • Levine Cancer Institute

    Charlotte, North Carolina, 28203

  • Ann & Robert H. Lurie Children's Hospital of Chicago

    Chicago, Illinois, 60611

  • Nationwide Children's Hospital

    Columbus, Ohio, 43205

  • Duke University Medical Center

    Durham, North Carolina, 27710

  • University of Florida College of Medicine

    Gainesville, Florida, 32610

  • Hackensack University Medical Center

    Hackensack, New Jersey, 07601

  • Texas Children's Hospital

    Houston, Texas, 77030

  • Riley Hospital for Children-Indiana University

    Indianapolis, Indiana, 46202

  • Arkansas Children's Hospital

    Little Rock, Arkansas, 72202

  • University of Wisconsin

    Madison, Wisconsin, 53792

  • St. Jude Children's Hospital

    Memphis, Tennessee, 38105

  • Children's Hospital and Clinics of Minnesota

    Minneapolis, Minnesota, 55404

  • Columbia University Irving Medical Center

    New York, New York, 10032

  • Weill Cornell Medical College

    New York, New York, 10065

  • University of Nebraska Medical Center

    Omaha, Nebraska, 68198

  • Children's Hospital of Orange County

    Orange, California, 92868

  • The Children's Hospital of Philadelphia

    Philadelphia, Pennsylvania, 19104

  • Phoenix CHildren's Hospital

    Phoenix, Arizona, 85016

  • Randall Children's Hospital

    Portland, Oregon, 97227

  • Oregon Health and Science University

    Portland, Oregon, 97239

  • Hasbro Children's Hospital

    Providence, Rhode Island, 02903

  • UCSF Benioff Children's Hospital

    San Francisco, California, 94158

  • Children's National Medical Center

    Washington D.C., District of Columbia, 20010

Other trials in United States

About this study

Official title: A Phase III Study of Eltrombopag vs Standard Front Line Management for Newly Diagnosed Immune Thrombocytopenia in Children

This is an investigator initiated, multicenter, open label, randomized phase 3 study for subjects with newly diagnosed ITP from ages 1 to less than 18 years old.

Read the detailed description

This is a prospective, open label, randomized, two-arm, multi-center Phase 3 trial.

Patients with newly diagnosed ITP are randomized 2:1 to receive the experimental treatment, eltrombopag, or investigator's choice of 3 standard therapies. The primary objective is to determine if the proportion of patients with platelet response is significantly greater in patients treated with eltrombopag compared to those treated with standard therapies.

Being tested
Eltrombopag, Steroids, IVIG, Rho(D) Immune Globulin
Keywords
ITP, Immune Thrombocytopenia, Newly Diagnosed Immune Thrombocytopenia, Newly Diagnosed ITP
Medical subject headings
Purpura, Thrombocytopenic, Idiopathic

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • EltrombopagDrug

    Starting dose for eltrombopag will be based on manufacturer recommendations, and drug will be titrated to effect per guidelines.

    • Children 1 to 5 years: Initial: 25 mg once daily
    • Children ≥6 years and Adolescents: Initial: 50 mg once daily (25 mg once daily for patients of East-Asian ethnicity [e.g., Chinese, Japanese, Korean, Taiwanese])

    Dose should be titrated based on platelet response. Maximum dose: 75 mg once daily.

  • SteroidsDrug

    Prednisone/Prednisolone 4mg/kg/day (Max 120 mg/day) x 4 day

  • IVIGDrug

    IVIG 1 g/kg x1 (no steroids for pre-medication or adjunctive therapy)

  • Rho(D) Immune GlobulinDrug

    Anti-D globulin 75 mcg/kg x1 (no steroids for pre-medication or adjunctive therapy)

Study groups in NCT03939637
Study groupRoleWhat they receive
EltrombopagExperimentalPatients randomized to eltrombopag will be treated for 12 weeks, with the possibility to continue therapy for up to 1 year depending on response.
Receives: Drug: Eltrombopag
Standard first-line therapyActive comparatorSubjects randomized to the standard therapy arm will receive one of three treatments at the discretion of the treating physician. Patients who previously failed standard management prior to study entry must be treated with a different agent than their original failed agent. e.g. Patient who failed steroids could receive either IVIg or anti-D if randomized to the standard treatment arm. Standard therapy will be administered as commercially available drug. Investigator may choose amongst the following: * IVIg: IVIG 1 g/kg x1 (no steroids for pre-medication or adjunctive therapy) * Steroids: Prednisone/Prednisolone 4 mg/kg/day (Max 120 mg/day) x 4 days * Rho(D) Immune Globulin: Anti-D globulin 75 mcg/kg x1 (no steroids for pre-medication or adjunctive therapy)
Receives: Drug: Steroids; Drug: IVIG; Drug: Rho(D) Immune Globulin

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Proportion of Patients With a Platelet Response

    To determine if the percentage of patients with a platelet response is significantly greater in patients with newly diagnosed ITP treated with eltrombopag than those treated with standard first-line treatments

    Measured: 12 weeks

Secondary outcomes (11)
  1. Bleeding Score

    Poor bleeding score (binary) at 1, 2, 3, 4 weeks, 12 weeks, and 1 year after study enrollment defined as World Health Organization (WHO) Bleeding Scale ≥ 2 or Modified Buchanan Scale ≥ 3

    Measured: 1 year

  2. Cumulative Number of Rescue Therapies Required

    The percentage of patients who received rescue therapy in the experimental (eltrombopag) arm vs the comparator (standard therapy) arm during the first 12 weeks of treatment

    Measured: 12 weeks

  3. Platelet Response Among Patients Requiring Rescue Therapy During Weeks 1-2 of Study

    Platelet response (binary), defined as ≥ 3 of 4 weeks with platelets >50 x109/L during weeks 6-12 of therapy, but patient required a rescue treatment during weeks 1-2 of study.

    Measured: 12 weeks

  4. Need for Treatment

    No further need for treatment (binary) after 12 weeks or 6 months of study

    Measured: 6 months

  5. Treatment Response

    Treatment response (binary endpoints) at 1 year defined as:

    • CR is defined as platelet count >/= 150 x 10^9/L
    • Primary Remission at 1 year is defined as CR at 1 year with no second-line agents required and >/= 3 months after discontinuing most recent platelet active medication
    • Disease resolution at 1 year is defined as complete response (CR) at 1 year >/= 3 months after discontinuing most recent platelet active medication. May have received a second-line therapy, excluding rituximab or splenectomy.
    • Disease stability at 1 year is defined as platelets >/= 50 x 10^9/L but <150 x 10^9/L >/= 3 months after discontinuing most recent platelet active medication.

    Measured: 1 year

  6. Number of 2nd Line Therapies

    Number of 2nd-line therapies in weeks 13-52

    Measured: 52 weeks

  7. Regulatory T-Cells

    Absolute change in percentage of CD4+25+Foxp3+ regulatory T cells from baseline at 12 weeks and 1 year

    Measured: 1 year

  8. KIT Scores

    Change in parent proxy-reported Kids ITP tool (KIT) overall scores from baseline at 1 week, 4 weeks, 12 weeks, and 1 year after study enrollment

    Measured: 1 year

  9. Hockenberry Fatigue Scale-Parent

    Total scale intensity ratings (continuous) from the Hockenberry Fatigue Scale-Parent (FS-P) at 1 week, 4 weeks, 12 weeks, and 1 year

    Measured: 1 year

  10. Blood Iron Values

    Serum iron, total iron binding capacity (TIBC), transferrin saturation, ferritin, mean corpuscular volume (MCV), and hemoglobin at 12 weeks, 6 months, and 1 year after study enrollment

    Measured: 1 year

  11. Safety Evaluations

    Safety evaluations as defined by:

    • Abnormal liver function tests (LFTs):

    ALT ≥ 3 x upper limit of normal (ULN) in patients with normal baseline ALT ≥ 3 x baseline or ≥ 5 x ULN (whichever is lower) in patients with abnormal baseline ALT ≥ 3 x ULN AND bilirubin ≥ 1.5 x ULN (>35% direct)

    • Incidence of adverse events
    • Incidence of serious adverse events

    Measured: 1 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 May 2019
  2. Study start2 May 2019
  3. Primary completion17 Apr 2024
  4. Study completion26 Feb 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
122 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03939637
Sponsor's protocol ID
H-42131 ICON 3
Other IDs
CETB115JUS33T, ICON 3
Status last verified
Jul 2025
First submitted
25 Apr 2019
Last updated
29 Jul 2025
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No

Publications

  • Shimano KA, Grimes AB, Kaicker S, Shah SJ, Gunn E, Bhat RV, Kochhar M, Rothman JA, Rose MJ, Briones M, Nakano TA, Lebensburger JD, Lambert MP, Fritch Lilla SA, Jesudas R, Lee-Miller CA, Thompson AA, Rifkin-Zenenberg S, Majumdar S, Crary SE, Hege K, Ford JB, Bies JJ, Fort J, Wynn TT, Hsieh L, Ruiz ME, Dinu B, Wong JMW, Kao PC, Kim TO, Arnold SD, Bennett CM, Despotovic JM, Klaassen RJ, Neufeld EJ, Neunert CE, London WB, Grace RF. Eltrombopag for Newly Diagnosed Pediatric Immune Thrombocytopenia Requiring Treatment: The PINES Randomized Clinical Trial. JAMA. 2025 Nov 25;334(20):1816-1826. doi: 10.1001/jama.2025.18168.

    PubMed 41123939
  • Shimano KA, Grace RF, Despotovic JM, Neufeld EJ, Klaassen RJ, Bennett CM, Ma C, London WB, Neunert C. Phase 3 randomised trial of eltrombopag versus standard first-line pharmacological management for newly diagnosed immune thrombocytopaenia (ITP) in children: study protocol. BMJ Open. 2021 Aug 27;11(8):e044885. doi: 10.1136/bmjopen-2020-044885.

    PubMed 34452956

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Eltrombopag, Steroids and IVIG in people with Immune Thrombocytopenia, run by Baylor College of Medicine at 27 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 13 inclusion and 38 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 29 Jul 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 27 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 29 Jul 2025). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Proportion of Patients With a Platelet Response (time frame: 12 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03939637, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Jul 2025.

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