Clinical Epidemiology, Treatment Outcome and Mortality Rate of Newly Diagnosed Immune Thrombocytopenia in Adult Multicentre Study in Malaysia

Abstract

Background Immune thrombocytopenia (ITP) is well characterized in Western, European and other Asia-Pacific countries. Nevertheless, the clinical epidemiology, treatment pattern and disease outcome of ITP in Malaysia are still limited and not well known. Objective This study aimed to describe the clinical epidemiology, treatment outcome and mortality of ITP patients in haematology tertiary multicentre in Malaysia. Methods Clinical and laboratory data of newly diagnosed adults with ITP by a platelet count <100 × 10 9 /L from January 2010 to December 2020 were identified and analyzed. Results Out of 500 incident ITP, 71.8% were females with a striking age preponderance of both genders among those aged 18–29 years. The median age was 36 years. The median platelet count was 17.5 × 10 9 /L, 23.0% had a secondary ITP, 34.6% had a Charlson’s score ≥1, 53.0% had bleeding symptoms including 2.2% intracranial bleedings (ICB). Helicobacter pylori screening was performed in <5% of cases. Persistency and chronicity rates were 13.6% and 41.8%, respectively. Most (80.6%) were treated at diagnosis onset and 31.2% needed second-line treatment. Throughout the course of ITP, 11.0% of patients died; 3.0% and 8.0% with bleeding and non-bleeding related ITP. Conclusion This study confirms the epidemiology of ITP is comparable with worldwide studies. Our incidence is high in the female, Malay ethnicity, primary ITP and events of cutaneous bleeding at ITP onset with 18–29 years predominance age group for both genders. The frequency of persistent and chronic ITP is inconsistent with published literature. Corticosteroids and immunotherapies are the most prescribed first-line and second-line pharmacological treatments. Thrombopoietin receptor agonist medications (TPO-RAs) usage is restricted and splenectomy is uncommon. Our mortality rate is similar but ITP related bleeding death is fourth-fold lower than previous studies. Mortality risks of our ITP patients include age ≥60 years, male, severe bleeding at presentation, CCI≥1 and secondary ITP.

Treatment outcomes and adherence to treatment in patients with immune thrombocytopenia in two Ethiopian teaching hospitals: a retrospective cohort study

“…Most epidemiologic data suggest that women are more commonly affected by ITP during their childbearing age and that the prevalence after menopause is similar to that of men [6][7][8]43,44 . In this study, 75.5% of the study participants were female, which is consistent with other studies from the United States of America (76%) 45 , Turkey (71.3%) 46 , and Malaysia (71.8%) 36 . In our study, the proportion of females was higher than that in studies conducted in the United Kingdom (56.9%) 8 , Germany (57%) 47 , China (63.6%) 48 , and in the ITP World Impact Survey data (65%) 17 but lower than that in studies conducted in Mexico (81.8%) 49 and Egypt (84%) 50 .…”

“…Treatment outcome tools. After an extensive review of the literature [36][37][38][39] and with the help of experts, structured questionnaires were designed to evaluate the treatment outcomes of ITP patients.…”

An Epidemiology Study of Adult Immune Thrombocytopenia Patients in a Teaching Hospital in Northeastern Malaysia

“…Our study confirms that the prevalence of Malay ITP patients is the highest compared to other ethnic groups (Chinese and Indian), as reported by previous local studies in Perak and Selangor [ 9 , 14 ]. About 63% of the total population in Peninsular Malaysia is constituted by Malays [ 18 ], thus establishing their dominance in the research.…”

“…Furthermore, our study noted a significantly higher ITP incidence rate among females compared to males, which is comparable with previous studies from the United Kingdom (58.22/100,000 versus 40.66/100,000 person-years) and France (3.03/100,000 versus 2.77/100,000 person-years) [ 2 , 20 ]. Additionally, local research also observed higher ITP rates among female young adults (<65 years old) [ 14 ].…”

“…In this retrospective study, we also conducted an extensive comparison of ITP incidence rates within the country with those of global general populations (Table 3 ). Thus, we calculated the incidence rates in Perak [ 9 ] and Selangor [ 14 ] using the demographic data provided by the Department of Statistics of Malaysia [ 27 ]. In summary, the incidence of ITP in Peninsular Malaysia registers at less than 10 cases per 100,000 person-years.…”