Abstract Number: PB0824
Meeting: ISTH 2021 Congress
Background: A small proportion of patients with immune thrombocytopenia (ITP) do not respond to conventional treatments, they may benefit from combined therapy with thrombopoietin analogs and immunosuppressants.
Aims: To describe our experience in the treatment of refractory ITP with combination of TPO-RA and immunosuppressants, with focus on response and safety.
Methods: We study adults with refractory ITP considering refractoriness not reaching platelets higher than 30 x10^9/L or corticosteroid-dependence. All patients were diagnosed and treated in the same center with combined treatment after failure of monotherapy. We consider complete response a platelet count higher than 100 x10^9/L and response by a platelet count 30-100 x10^9/L, according to the international recommendations. We report adverse events of 6 weeks after the combination (infections requiring hospital admission and thromboembolic events as deep vein thrombosis and pulmonary embolism).
Results: We analyzed 13 adult patients, 73 % female, median age 52 (range 18-85). Two had secondary ITP, eleven had primary ITP. Four had previous Splenectomy, not performed in 9 because of contraindication or patient refusal. At the time of combination, median platelet count was 18 x10^9/L (4-33), median duration of ITP was 28 months (2-216). The combination therapy includes a thrombopoetin analog (romiplostim or eltrombopag) with an immunosuppressant, azathioprine in 70% of them and corticosteroids in 30%. Nine patients (69%) respond to the combination. Seven reached complete response, durable after a median follow up of 23 months. In fact, two cases maintain response after discontinuation. Just one did not respond and three remain cortico-dependent. The median time response was 14 days (7-20). Two patients experienced a thromboembolic event and just one had an infection. Combination was well tolerated in all of them but one.
Conclusions: Patients with refractory ITP, may benefit from treatment combinations with an acceptable safety profile. More studies are needed to support this conclusions.
To cite this abstract in AMA style:Sánchez Bazán I, Martín Téllez S, López Jaime FJ, Muñoz MI. Refractory Immune Thrombocytopenia (ITP): The Combination of Thrombopoietin Analogs and Immunosuppressants, Experience in a Single Spanish Center [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/refractory-immune-thrombocytopenia-itp-the-combination-of-thrombopoietin-analogs-and-immunosuppressants-experience-in-a-single-spanish-center/. Accessed December 2, 2022.
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