A decade of changes in management of immune thrombocytopenia, with special focus on elderly patients

https://doi.org/10.1016/j.bcmd.2020.102505Get rights and content
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Abstract

Background

Ten years after their availability, thrombopoietin receptor agonists (TPO-RA) have heralded a paradigm shift in the treatment of immune thrombocytopenia (ITP). This study was aimed to analyze the implementation of current recommendations in the standard practice of adult ITP patients, and how age may influence those changes.

Methods

We included 121 adult patients (> 65 years, n = 54; younger individuals, n = 67) who initiated treatment with TPO-RA between January 2012 and December 2014.

Results

Patients older than 65 years treated with TPO-RA presented at diagnosis with significantly higher platelet counts, less bleeding, and a more prothrombotic profile than younger ones. The high efficacy rates of TPO-RA, preferentially used during the last decade in non-chronic phases, precluded from further therapies in the majority of ITP patients. Their administration was associated with a sharp decline in the last decade in the use of splenectomy and intravenous immunoglobulin, especially in younger ITP individuals.

Conclusion

These results confirm (1) that there is a preferential use of TPO-RAs in elderly ITP patients with fewer bleeding complications but more unfavorable prothrombotic conditions than in younger individuals, and (2) that early use of these agents has been established as an effective therapeutic alternative to other second line therapies.

Abbreviations

ASH
American Society of Hematology
CBC
Complete blood count
ITP
Immune thrombocytopenia
IVIG
Intravenous immunoglobulins
TPO-RA
Thrombopoietin receptor agonists
VE
Vascular events

Keywords

ITP
TPO-RA
Guidelines
Elderly

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