Effect of a thrombopoietin receptor agonist on use of intravenous immune globulin in patients with immune thrombocytopenia

Zeller, Michelle P.; Heddle, Nancy M.; Kelton, John G.; Hamilton, Korinne; Wang, Grace; Sholapur, Naushin S.; Carruthers, Julie; Hsia, Cyrus C.; Blais, Normand; Toltl, Lisa J.; Hamm, Caroline; Pearson, Marc-André; Arnold, Donald M.

doi:10.1111/trf.13336

Cited by 10 publications

(7 citation statements)

References 25 publications

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“…In 1 study of humans with ITP, the IBLS was reported to be associated with platelet count, but this association did not persist for patients with platelet counts < 30,000/μL, likely because of the heterogeneity in clinical bleeding seen with severe thrombocytopenia. Since the initial description of the IBLS, several other publications in the human literature have implemented this bleeding score in ITP patients to make correlations between clinical bleeding severity and clinicopathologic variables and to assess clinical bleeding in treatment trials …”

Section: Discussionmentioning

confidence: 99%

“…Since the initial description of the IBLS, several other publications in the human literature have implemented this bleeding score in ITP patients to make correlations between clinical bleeding severity and clinicopathologic variables [24][25][26] and to assess clinical bleeding in treatment trials. 27,28 Although similar to the IBLS, several modifications tailor the DOGi- The training module instructed users on implementation of the DOGiBAT scoring tool. To evaluate the effects of training, veterinary students were utilized as a large population of individuals who likely had less clinical experience than the clinicians in phase 1.…”

Section: The Correlation Between Outcome Measures and Dogibat Andmentioning

confidence: 99%

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Development and implementation of a novel immune thrombocytopenia bleeding score for dogs

Makielski

Brooks

Wang

et al. 2018

Veterinary Internal Medicne

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BackgroundA method of quantifying clinical bleeding in dogs with immune thrombocytopenia (ITP) is needed because ITP patients have variable bleeding tendencies that inconsistently correlate with platelet count. A scoring system will facilitate patient comparisons and allow stratification based on bleeding severity in clinical trials.Hypothesis/ObjectivesTo develop and evaluate a bleeding assessment tool for dogs, and a training course for improving its consistent implementation.AnimalsClient‐owned dogs (n = 61) with platelet counts <50,000/μL; 34 classified as primary ITP, 17 as secondary ITP, and 10 as non‐ITP.MethodsA novel bleeding assessment tool, DOGiBAT, comprising bleeding grades from 0 (none) to 2 (severe) at 9 anatomic sites, was developed. Clinicians and technicians completed a training course and quiz before scoring thrombocytopenic patients. The training course was assessed by randomizing student volunteers to take the quiz with or without prior training. A logistic regression model assessed the association between training and quiz performance. The correlation of DOGiBAT score with platelet count and outcome measures was assessed in the thrombocytopenic dogs.ResultsClinicians and technicians consistently applied the DOGiBAT, correctly scoring all quiz cases. The odds of trained students answering correctly were higher than those of untrained students (P < .0001). In clinical cases, DOGiBAT score and platelet count were inversely correlated (r s = −0.527, P < .0001), and DOGiBAT directly correlated with transfusion requirements (r s = 0.512, P < .0001) and hospitalization duration (r s = 0.35, P = .006).Conclusions and Clinical ImportanceThe DOGiBAT and assessment quiz are simple tools to standardize evaluation of bleeding severity. With further validation, the DOGiBAT may provide a clinically relevant metric to characterize ITP severity and monitor response in treatment trials.

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Section: Discussionmentioning

confidence: 99%

Section: The Correlation Between Outcome Measures and Dogibat Andmentioning

confidence: 99%

Development and implementation of a novel immune thrombocytopenia bleeding score for dogs

Makielski

Brooks

Wang

et al. 2018

Veterinary Internal Medicne

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“…A Púrpura Trombocitopênica Imune é uma doença mediada por auto-anticorpos caracterizada pela queda da contagem de plaquetas (< 100 x 10 9 ) e um risco aumentado de sangramento 1,4 . Sua via é a perda da tolerância do sistema imune aos auto-antígenos localizados na superfície das plaquetas e megacariócitos.…”

Section: Resultsunclassified

“…Para os pacientes com PTI, a escolha do tratamento inclui: esteroides, imunoglobulina intravenosa (IgIV), imunoglobulina anti-D, esplenectomia, rituximab, agentes estimuladores da trombopoiese e a terapia "watch and wait" 3 . Atualmente, as terapias de primeira linha padrão na contenção da trombocitopenia grave e sangramento incluem corticosteroides, imunoglobulina intravenosa (IgIV, 1-2 mg/kg) e imunoglobulina anti-D (anti-D), que são efetivos para mais de 80% dos pacientes 1,4,5 .…”

Section: Introductionunclassified

Uso de imunoglobulinas na terapêutica da púrpura trombocitopênica imune

Barros

Miranda

et al. 2019

RIB

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A trombocitopenia é um achado comum na prática clínica e a Púrpura Trombocitopênica Imune (PTI) é uma de suas várias causas, antigamente considerada idiopática. Caracteriza-se por doença autoimune com queda da quantidade absoluta de plaquetas e aumento do risco de sangramento. Para fins diagnósticos, divide-se em recentemente diagnosticada, persistente e crônica. Entre os 30 e 60 anos é mais prevalente em mulheres, tornando-se equivalente em ambos os sexos após essa idade e sendo mais autolimitada na infância. Entre os possíveis sintomas, podem ocorrer petéquias, equimoses, sangramento de mucosas, e outros, sendo que nem todos os pacientes apresentam sintomas. A primeira-linha terapêutica da PTI é composta por corticosteroides, imunoglobulina intravenosa (IgIV) e imunoglobulina anti-D. Ambas as imunoglobulinas levam tempos semelhantes para uma resposta inicial. Apesar dos estudos acerca dos mecanismos de ação da IgIV e seu potencial de supressão de auto-anticorpos, a literatura não é clara acerca de sua dose ótima, tempo de infusão e desconsidera seu alto custo neste tratamento. A anti-D pode ser alternativamente utilizada em paciente Rh(D)-positivos e com baço intacto. Ensaios clínicos adicionais são indispensáveis para otimizar o custo-efetividade na terapêutica da PTI, além de reduzir sua toxicidade. Palavras-chave: Púrpura. Trombocitopenia. Imunoglobulina.

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“…This study found that 2 of 29 ITP patients audited actually used more IVIG after romiplostim was started, suggesting that there may have also been difficulty in regulating their platelet counts. 18…”

Section: Discussionmentioning

confidence: 99%

Dynamic dosing of romiplostim in patients with immune thrombocytopenia purpura: Two case reports

Gilreath

Wei

Stolzmann

et al. 2018

J Oncol Pharm Pract

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Romiplostim is a thrombopoietin receptor agonist approved for the treatment of immune thrombocytopenia purpura. When following FDA-approved romiplostim prescribing recommendations to withhold treatment for platelet counts above 400k/µL, some patients exhibit a precipitous decline in their platelet count potentially causing patient harm. We present two cases where stable platelet counts were achieved only through persistent weekly dosing of romiplostim despite platelet counts above 400k/µL on the day of administration. Therefore, continuous weekly dosing of romiplostim despite platelet count being above 400k/µL combined with twice weekly vigilant monitoring is an alternative method of romiplostim dosing that mitigates severe fluctuations in platelets. We also discuss important details, postulated mechanisms, and evidence-based mitigation strategies.

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Effect of a thrombopoietin receptor agonist on use of intravenous immune globulin in patients with immune thrombocytopenia

Abstract: Romiplostim was associated with improved PLT counts and fewer IVIG infusions for most ITP patients. In practice, romiplostim was generally not continued long term and was cost neutral for overall ITP management.

Cited by 10 publications

References 25 publications

Development and implementation of a novel immune thrombocytopenia bleeding score for dogs

Development and implementation of a novel immune thrombocytopenia bleeding score for dogs

Uso de imunoglobulinas na terapêutica da púrpura trombocitopênica imune

Dynamic dosing of romiplostim in patients with immune thrombocytopenia purpura: Two case reports

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