Abstract Number: PB1199
Meeting: ISTH 2022 Congress
Background: Optimal treatment of adults with immune thrombocytopenia who do not respond to steroid or respond transiently is not known. Second line treatment options include immunomodulatory drugs, rituximab, emergency splenectomy or thrombopoietin (TPO) receptor agonists. Here we report our experience of treating these patients from a tertiary care center in India.
Aims: To evaluate treatment pattern and response in steroid refractory acute and persistent severe ITP patients.
Methods: Retrospective review of medical records of patients with ITP who did not respond to initial steroid therapy or who showed only a transient response was done from January 2017 to December 2021. Outcome data was analyzed for 2 line and subsequent treatment.
Results: A total of 56 patients (male 28: female 28) were identified. Eltrombopag was our preferred second line therapy and was given alone to 28 patients with 19 (75%) responded. Dapsone alone was given to 23 patients and lead to a response in 7 (30%) patients. Azathioprine alone was used in 11 patients and 3(27%) responded. Romiplostim alone was used in 7 patients with 2 (28%) response. TPO agonists were used in combination therapy in 11 patients (eltrombopag with Azathioprine in 4, or eltrombopag with dapsone in 3 patients) with 100% response which were maintained on withdrawal of eltrombopag. Similarly, romiplostim was used with azathioprine in 4 patients and 3 showed and complete response. Rituximab was given in 9 patients with 6(66%) response. Two patients underwent splenectomy and both responded. Of note three lines of therapies were given in 12/56 (22%) and 4 lines in 6/56 (11%) patients.
Conclusion(s): Outcome to steroid refractory acute and persistent adult ITP patients have improved with the availability of TPO agonists. Older therapies like dapsone or azathioprine still had a role to play in a resource constraint setting. TPO agonists can be safely and effectively combined with immunomodulatory drugs.
To cite this abstract in AMA style:GUPTA N, Balasubramanian R, Sivaprakasm Y, Gupta D. Changing treatment paradigm in second line treatment of adult ITP patients with the availability of TPO agonists: A retrospective study from a tertiary care center in India [abstract]. https://abstracts.isth.org/abstract/changing-treatment-paradigm-in-second-line-treatment-of-adult-itp-patients-with-the-availability-of-tpo-agonists-a-retrospective-study-from-a-tertiary-care-center-in-india/. Accessed September 24, 2023.
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