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Grade 3 and 4 adverse events of bleeding occurred in 10% and 1% of romiplostim-treated patients, respectively. Twenty-five percent of patients had a serious adverse event, most commonly epistaxis (6%). Seven patients (2%) had neutralizing antibodies against romiplostim postbaseline and none had neutralizing antibodies against endogenous thrombopoietin. Efficacy and safety results appeared similar between children with ITP for ≤12months and 12months at baseline. Across five pediatric clinical trials, romiplostim was well tolerate