OBJECTIVES: To establish a pan-European expert consensus on tapering and discontinuation of thrombopoietin receptor agonists (TPO-RAs) in patients with immune thrombocytopenia (ITP).

METHODS: A Delphi panel develops a group opinion through the systematic collection and aggregation of informed judgements from experts. We applied a 3-step modified Delphi technique, including a single 1:1 remote interview round and two online survey rounds. Three leading healthcare professionals (HCPs) from Italy, Spain and UK formed the Steering Committee (SC). The SC provided input to the study design, selection of panellists, and survey development. A literature review and inputs from the SC informed the development of the consensus statements. Quantitative data on the level of agreement of panellists were collected using Likert-type ranking scales. Consensus rules were agreed a priori.

RESULTS: Twelve haematologists with relevant experience, representing 9 European countries, participated. The questionnaire included a total of 121 statements spanning three categories: (1) patient selection; (2) tapering and discontinuation strategies; and (3) post-discontinuation management. Consensus was reached for approximately half of the statements in each category (53%; 49%; 60%). Panellists agreed on main patients' selection criteria, patient's involvement in decision-making, tapering regimens, and follow-up criteria. Key areas that did not reach consensus were risk factors and predictors of successful discontinuation, monitoring intervals and overall rates of discontinuation or relapse.

CONCLUSIONS: The results suggest that across 9 European countries, there is agreement on some approaches to tapering and discontinuation of TPO-RAs in patients with ITP. The aspects that did not reach consensus indicate that gaps in harmonization in tapering and discontinuation practices persist in different countries. This study highlights research needs for education of HCPs and development of clinical practice guidelines, which can provide the basis for a pan-European, evidence-based approach to tapering and discontinuation of TPO RAs.