Abstract Number: PB1382
Meeting: ISTH 2020 Congress
Background: Optimal management of the patients with acute immune thrombocytopenia refractory to steroid therapy is not known. Immunosuppressive/immunomodulator drugs (azathioprine, MMF, rituximab, dapsone etc.) or even splenectomy have been used in past. Now a days Thrombopoietin (TPO) receptor agonists are being used in difficult to treat population. Here we report our experience of treating these patients in real world resource constraint setting from India
Aims: To evaluate treatment and outcome to steroid refractory severe immune thrombocytopenia patients.
Methods: Retrospective review of medical records of patients with ITP who did not respond to steroid after one week of therapy or who showed only transient response was done from January 2017 to December 2019. Outcome data was analyzed for 2nd line and subsequent treatment
Results: A total of 30 patients (male 14: female 16) were identified. Dapsone was our preferred second line of therapy in early part of the study period as it is easily available and inexpensive, was given to 11 patients and lead to a response in 6 (54%) patients. Eltrombopag was given to 16 patients with 12 (75%) response. Romiplostim was used in only 4 patients (along with azathioprine) as a generic version has become available lately (innovator drug is not yet available in India) and all responded. Azathioprine alone was used in 6 patients and 2(33%) responded. Four patients did not respond to any of the second line therapy
Conclusions: Outcome to steroid refractory ITP patients have improved with the availability of TPO agonists (romiplostim and eltrombopag). About 80% patients will respond but relapse invariably happen on drug discontinuation. Older therapies like dapsone or azathioprine still had a role to play in a resource constraint setting, can be combined with TPO agonists and lasting responses can be seen in a subset of patients.
To cite this abstract in AMA style:Gupta N, Verma M, Mulam M, Purohit K, Gupta D, Kotwal J, Sharma A. Management of Steroid Refractory Acute Immune Thrombocytopenia Purpura – A Single Center Experience from India [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/management-of-steroid-refractory-acute-immune-thrombocytopenia-purpura-a-single-center-experience-from-india/. Accessed November 29, 2023.
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