Second‐line treatments and outcomes for immune thrombocytopenia: A retrospective study with electronic health records

Lal, Lincy S.; Said, Qayyim; Andrade, Katherine E; Cuker, Adam

doi:10.1002/rth2.12423

Cited by 11 publications

(6 citation statements)

References 26 publications

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“…Splenectomy, rituximab and thrombopoietin receptor agonists (TPO‐RAs) have the most robust evidence in terms of efficacy and safety and hence it is recommended that these three options be discussed with patients as suitable second line treatments (GRADE 1C) 33 (Box 2). Some patients are reluctant to undergo splenectomy if there is a non‐surgical alternative 34,35 .…”

Section: Second Line Treatmentsmentioning

confidence: 99%

Consensus guidelines for the management of adult immune thrombocytopenia in Australia and New Zealand

Choi

Merriman

Bennett

et al. 2021

Medical Journal of Australia

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Introduction The absence of high quality evidence for basic clinical dilemmas in immune thrombocytopenic purpura (ITP) underlines the need for contemporary guidelines relevant to the local treatment context. ITP is diagnosed by exclusions, with a hallmark laboratory finding of isolated thrombocytopenia. Main recommendations Bleeding, family and medication histories and a review of historical investigations are required to gauge the bleeding risk and possible hereditary syndromes. Beyond the platelet count, the decision to treat is affected by individual bleeding risk, disease stage, side effects of treatment, concomitant medications, and patient preference. Treatment is aimed at achieving a platelet count > 20 × 109/L, and avoidance of severe bleeding. Steroids are the standard first line treatment, with either 6‐week courses of tapering prednisone or repeated courses of high dose dexamethasone providing equivalent efficacy. Intravenous immunoglobulin can be used periprocedurally or as first line therapy in combination with steroids. Changes in management as a result of this statement There is no consensus on choice of second line treatments. Options with the most robust evidence include splenectomy, rituximab and thrombopoietin receptor agonists. Other therapies include azathioprine, mycophenolate mofetil, dapsone and vinca alkaloids. Given that up to one‐third of patients achieve a satisfactory haemostatic response, splenectomy should be delayed for at least 12 months if possible. In life‐threatening bleeding, we recommend platelet transfusions to achieve haemostasis, along with intravenous immunoglobulin and high dose steroids.

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Section: Second Line Treatmentsmentioning

confidence: 99%

Consensus guidelines for the management of adult immune thrombocytopenia in Australia and New Zealand

Choi

Merriman

Bennett

et al. 2021

Medical Journal of Australia

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“…These findings align with observations in primary ITP, which show that approximately one-third of patients on eltrombopag are ultimately able to sustain a durable platelet response off all treatment. [20][21][22].…”

Section: Discussionmentioning

confidence: 99%

Eltrombopag treatment of patients with secondary immune thrombocytopenia: retrospective EHR analysis

et al. 2021

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Immune thrombocytopenia (ITP) may occur in isolation (primary) or in association with a predisposing condition (secondary ITP [sITP]). Eltrombopag is a well-studied treatment for primary ITP, but evidence is scarce for sITP. We evaluated real-world use of eltrombopag for sITP using electronic health records. Eligible patients had diagnoses of ITP and a qualifying predisposing condition, and eltrombopag treatment. We described patient characteristics, treatment patterns, platelet counts, and thrombotic and bleeding events. We identified 242 eligible patients; the most common predisposing conditions were hepatitis C and systemic lupus erythematosus. Average duration of eltrombopag treatment was 6.1 months. Most (81.4%) patients achieved a platelet count ≥ 30,000/µL at a mean of 0.70 months, 70.2% reached ≥ 50,000/µL at a mean of 0.95 months, and 47.1% achieved a complete response of > 100,000/µL at a mean of 1.43 months after eltrombopag initiation. At eltrombopag discontinuation, 105 patients (43%) experienced a treatment-free period for a mean 3.3 months. Bleeding events occurred with similar frequency before and during eltrombopag treatment whereas thrombotic events were less frequent during eltrombopag treatment. Our results suggest similar rates of platelet response with eltrombopag in patients with sITP as compared with primary ITP. In addition, a treatment-free period is possible for a substantial minority of patients.

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“…Splenectomy, rituximab, and TPO-RAs have not been directly compared in randomized trials [ 26 ]. However, the reported initial response rates are higher for splenectomy than for rituximab (60%–80% versus 55%–65%), and the responses with splenectomy are more durable, often lasting for many years or even indefinitely for splenectomy versus 1–2 years for rituximab [ 28 , 41 ]. There are also significant differences in the short- and long-term risks of splenectomy versus rituximab [ 41 – 43 ].…”

Section: Treatment Options For Primary and Secondary Immune Thrombocy...mentioning

confidence: 99%

Bisphosphonate use for glucocorticoid-induced osteoporosis in older patients with immune thrombocytopenia: a clinical perspective

Yamasaki

2023

Ann Hematol

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Prednisolone, used as a standard initial treatment for immune thrombocytopenia (ITP), is an important risk factor for osteoporosis. Recently, we found that prescription of bisphosphonate during initial loading of prednisolone may prevent reduction in bone mineral density and development of glucocorticoid-induced osteoporosis (GIO) in older patients with ITP receiving prolonged steroid therapy. In this review, I describe the treatment options for older patients with ITP, and present the best practices for screening, evaluating, and diagnosing ITP. I also summarize the literature from 2017 to 2022 on the treatment options for ITP, including discussions on the contraindications and side effects, with an emphasis on GIO, and the relative merits of bisphosphonates as a co-treatment for prevention of GIO. Finally, I present a perspective and an expert recommendation on how older patients with ITP would best be served in the future.

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Second‐line treatments and outcomes for immune thrombocytopenia: A retrospective study with electronic health records

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 11 publications

References 26 publications

Consensus guidelines for the management of adult immune thrombocytopenia in Australia and New Zealand

Consensus guidelines for the management of adult immune thrombocytopenia in Australia and New Zealand

Eltrombopag treatment of patients with secondary immune thrombocytopenia: retrospective EHR analysis

Bisphosphonate use for glucocorticoid-induced osteoporosis in older patients with immune thrombocytopenia: a clinical perspective

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