Treatment patterns in adults with immune thrombocytopenia before, during and after use of thrombopoietin receptor agonists: a longitudinal prescription database study from Germany

Abstract

Objective: To assess real-world treatment patterns in patients with immune thrombocytopenia (ITP) who received thrombopoietin receptor agonists (TPO-RAs) in Germany. Methods: This was a longitudinal, retrospective study using anonymized patient-level data (IQVIA healthcare prescription database, covering 82% of German statutory prescriptions). Eligible patients (aged ≥18 years) had received ≥1 TPO-RA prescription (romiplostim/ eltrombopag) from July 2016 to June 2019 (treatment duration ≥30 days). ITP medication use was assessed for 18 months prior to, during and for ≥6 months after TPO-RA treatment. Results: A total of 3553 patients (median age 64 years) were included. Median persistence on TPO-RAs was 12 months (range 1-34). In the periods before, during and after TPO-RA treatment, oral corticosteroids were the most commonly used therapy (64.4%, 43.4% and 36.1% of patients, respectively); median cumulative doses across each period were 2521.9, 2000.0 and 2277.8 mg. The median total duration of corticosteroid use before, during and after TPO-RA therapy was 15, 18 and 32 weeks, respectively. The total median cumulative corticosteroid dose was 6799.7 mg. Conclusion:We identified a potential overuse of corticosteroids in patients with ITP in Germany. Earlier use of TPO-RA therapy after a short course of corticosteroids could avoid side effects associated with long-term use.

Expert Report on Immune Thrombocytopenia: Current Diagnostics and Treatment – Recommendations from an Expert Group from Austria, Germany, and Switzerland

“…Corticosteroids achieve an initial rise in platelet counts in 60-80% of adult ITP patients, but counts decline when the dose is decreased or the agent discontinued, and only 30-50% of patients maintain a stable, steroid-free remission. Recent studies show that corticosteroids are prescribed too often and for too long periods [39,40].…”

Outcomes of switching to avatrombopag following treatment failure with eltrombopag in paediatric immune thrombocytopenia: A real‐world study in China

“…This study found that AVA is an effective second‐line modality after treatment failure with ELT in the heavily pretreated paediatric cITP population. Although adherence to dietary restrictions 21 (effect of food and polyvalent cation), while taking ELT therapy may explain some differences in efficacy between ELT and AVA, subtle mechanistic differences such as molecular structure, pharmacokinetic profile and the manner in which they stimulate the TPO receptor appear to have clinically relevant effects 14,22 . To the best of our knowledge, this is the first real‐world retrospective study focusing on paediatric patients with cITP in China whose treatment was switched to AVA after treatment failure with ELT.…”

“…Although adherence to dietary restrictions 21 (effect of food and polyvalent cation), while taking ELT therapy may explain some differences in efficacy between ELT and AVA, subtle mechanistic differences such as molecular structure, pharmacokinetic profile and the manner in which they stimulate the TPO receptor appear to have clinically relevant effects. 14,22 To the best of our knowledge, this is the first real-world retrospective study focusing on paediatric patients with cITP in China whose treatment was switched to AVA after treatment failure with ELT. Consistent with the previous findings, [23][24][25][26] this study found that AVA is effective as a second-line treatment after failure with ELT, with 81.8% of the patients achieving OR.…”

Expertenreport Immunthrombozytopenie – Aktuelle Diagnostik und Therapie

“…Aktuelle Studien zeigen, dass auch heute noch viele Patient*innen zu lange und zu häufig Glukokortikoide bekommen [39,40].…”