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hydroxychloroquine + eltrombopag is a combination therapy being investigated for the treatment of antinuclear antibody (ANA)-positive primary immune thrombocytopenia (ITP). Hydroxychloroquine is a small molecule 4-aminoquinoline with immunomodulatory properties, traditionally used as an antimalarial and for autoimmune conditions like systemic lupus erythematosus; it works by inhibiting toll-like receptors (TLR7/9) and modulating lysosomal pH to interfere with antigen presentation. Eltrombopag is an orally active, small molecule thrombopoietin receptor (TPO-R) agonist that interacts with the transmembrane domain of the receptor to initiate signaling pathways that increase megakaryocyte proliferation and platelet production. This specific combination, studied by Yunfeng Cheng at Zhongshan Hospital, aims to leverage the immune-modulating effects of hydroxychloroquine to enhance the platelet-stimulating efficacy of eltrombopag in ITP patients with underlying autoimmunity indicated by ANA positivity.
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