Epidemiology of incident immune thrombocytopenia: a nationwide population-based study in France

Abstract

Key Points• Incidence of ITP was 2.9/100 000 person-years with age, seasonal, and regional variations; in adults, 18% were secondary. • Severe (gastrointestinal or central nervous system) bleeding at ITP onset was rare (,1%); the risk increased with age.The epidemiology of immune thrombocytopenia (ITP) is not well known. The purpose of this study was to assess ITP incidence at a nationwide level (France) with recent data (mid-2009 to mid-2011; 129 248 543 person-years). The data source is the French health insurance database. We selected cases with diagnosis codes for in-hospital stays and long-term disease attributions, thus restricting our search to ITPs necessitating health care. We studied incidence by age, gender, calendar month, regions, and proportion of secondary ITPs, of ITPs becoming persistent or chronic, and of severe bleeding at disease onset. We identified 3771 incident ITP patients. Incidence was 2.9/100 000 person-years, with peaks among children and in those >60 years of age. ITP was more frequent among males in these subgroups. The incidence was lower in overseas Caribbean French departments, suggesting a lower incidence among Afro-American people. There was a northsouth gradient in mainland France and seasonal variations (peak in winter and nadir in summer). Persistence or chronicity occurred in 36% of children compared with 67% of adults. Among adults, 18% of ITPs were secondary. Malignancy was the main cause (10.9%). Myelodysplastic syndromes were not rare (2.3%). Severe gastrointestinal or central nervous system bleeding at ITP onset was rare (<1%). (Blood. 2014;124(22):3308-3315)

Seasonal Association of Immune Thrombocytopenia in Adults

“…The second study was performed in Bangladesh where a tropical climate exists. A recent study from France searching the epidemiology of incident ITP showed that incidence varied cyclically in the year, with a peak in January and nadir in the summer for both in adults and children (13). However, this study included not only cases with primary ITP, but also those with secondary ITP.…”

“…The role of the influenza virus has been suspected for a long time (14). It could play a direct role in the ITP pathogenesis by promoting antiplatelet-antibodies production and/ or decreasing platelet production (13). The pathogenic role of influenza vaccine is also debated, particularly in older patients (15)(16)(17)(18).…”

How we manage immune thrombocytopenia in the elderly

“…Among older adults, males are more affected than women (Frederiksen & Schmidt, 1999;Neylon et al, 2003). A recent large epidemiological study, based on the French health insurance database, confirmed this finding, showing a peak incidence in adults after 60 years of age, reaching 9/100 000 personyears [95% confidence interval (CI): 8Á21-9Á95] in men after 75 years of age (Moulis et al, 2014). With prolonged life expectancy and population aging, this medical situation is becoming more frequent.…”

“…One Danish and one Italian study found no association between age and bleeding (Frederiksen & Schmidt, 1999; ), but other studies suggested that older ITP patients with a platelet count <30 9 10 9 /l are at greater risk of bleeding (Cortelazzo et al, 1991;Bourgeois et al, 2003;Bizzoni et al, 2006;Daou et al, 2008). A recent French nationwide ITP study showed a linear correlation between age and both risk of gastrointestinal bleeding and cerebral haemorrhage (Moulis et al, 2014). Among 1817 patients reported in a large meta-analysis of 17 clinical case series, 49 had a fatal haemorrhage; the risk of fatal events ranged from 0Á4% per year for patients younger than 40 years to 13% per year for those 60 years and older (Cohen et al, 2000).…”

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“…Adverse events due to corticosteroids are of concern because steroid-derived side effects can be obstacles in clinical courses of ITP therapy, especially in elderly people; 10 the peaks of etiology in ITP exist in elderly people as well as in children. 19 The incidence of steroid-derived adverse events, in general, depends greatly on both the average dose and cumulative duration of use, 20 indicating that it is essential to both complete whole courses of therapy in as a short period as possible and reduce the total amount of administered corticosteroids. In this respect, although the Dex arm required higher amounts of corticosteroids especially in the Dex with posttherapy subgroup, the lower frequency of adverse events was likely due to the shorter therapeutic periods.…”