<p>Treatment Patterns Among Adults with Primary Immune Thrombocytopenia Diagnosed in Hematology Clinics in the United States</p>

Abstract

Purpose: Patients with immune thrombocytopenia (ITP) have low platelet counts and an increased risk of bleeding. We described treatment patterns and clinical outcomes in routine practice in the United States (US). Patients and Methods: Using electronic health record data from hematology/oncology clinics linked to administrative claims in the US, we studied 447 adults newly diagnosed with primary ITP from 2011 to 2016. Patients with a secondary cause of thrombocytopenia were excluded. The incidence of ITP treatment initiation, bleeding events, and rescue therapy use were estimated using competing risk models. Results: At 1-year post-ITP diagnosis, 50% of patients were prescribed an oral corticosteroid, with the majority being prescribed immediately following diagnosis. Of the more common secondline options, rituximab use was the most frequent (1-year cumulative incidence: 16% [95% confidence interval: 12, 19]), followed by romiplostim (9% [7, 12] and eltrombopag (5% [3, 8]). Use of these drugs was similar at 2 years post-diagnosis. At 6 months post-ITP treatment initiation, the cumulative incidence of bleeding was similar among eltrombopag and romiplostim initiators (17% [6, 33] and 19% [9, 31], respectively) and was slightly lower in rituximab users (12% [6, 20]). However, during this same timeframe, rituximab users had a higher incidence of rescue therapy use (48% [36, 58] versus 29% [14, 46] in eltrombopag and 26% [14, 39] in romiplostim users). Although splenectomy was rare, at 6 months post-surgery nearly 20% had experienced a bleed and nearly 20% had required rescue. Conclusion: This study describes the health trajectory of adults with ITP who are managed in hematology clinics in the US and could inform the design of non-interventional studies of comparative effectiveness among treatments.

Primary Immune Thrombocytopenia: Novel Insights into Pathophysiology and Disease Management

“…Glucocorticoid treatment is the most-commonly used first-line therapy in patients with ITP [43,75]. The beneficial effects of glucocorticoids include reduction of platelet Glucocorticoid treatment is the most-commonly used first-line therapy in patients with ITP [43,75]. The beneficial effects of glucocorticoids include reduction of platelet clearance by reticuloendothelial system [76,77].…”

“…Glucocorticoid treatment is the most-commonly used first-line therapy in patients with ITP [ 43 , 75 ]. The beneficial effects of glucocorticoids include reduction of platelet clearance by reticuloendothelial system [ 76 , 77 ].…”

“…Compared to other treatment options, splenectomy has a higher sustainable response rate [ 4 ]. However, with the introduction of new medicaments, splenectomy has lost its place in the treatment of ITP [ 75 , 145 ].…”

The Role of Oncology Pharmacists in optimizing patient care in Chronic Immune Thrombocytopenia

“…It is recommended to use actual body weight when calculating the dose of romiplostim. Doses can be raised weekly in amounts of 1 mcg/kg before the patient has a platelet count of 50,000/mm 3 or greater [20]. The median onset of action for thrombopoietin receptor agonist is 1 to 2 weeks [6].…”

“…It does not carry any black box warnings, but common adverse effects include headaches, dizziness, bruising, arthralgia, and myalgia [19]. Additionally, romiplostim possibly increases the risk of thrombosis [20].…”