Abstract Number: OC 73.3
Meeting: ISTH 2022 Congress
Theme: Platelet Disorders, von Willebrand Disease and Thrombotic Microangiopathies » Acquired Thrombocytopenias
Background: Adult primary immune thrombocytopenia (ITP) is a rare acquired immune-mediated disorder. It may have a more aggressive course in older patients with the potential for more complex management due to co-morbidities and possible drug interactions. Thrombopoietin receptor agonists (TPO-RAs) have reported overall response rates of 50-90% in ITP.
Aims: To assess outcomes after TPO-RA in patients >60y.
Methods: Data analysed from the UK adult primary ITP registry (https://www.qmul.ac.uk/itpregistry/) for response and events of special interest.
Results: There were 4590 participants as of 4th January 2021. Of these 485 patients (259M; 226F, median age 73y (IQR 67.9-79.2) >60y had received TPO-RA therapy (253 eltrombopag and 232 romiplostim) (Table 1). The mean time from diagnosis to first TPO-RA treatment was 1.8 years, with median 3 lines of treatment prior to TPO-RA. The median platelet count up to 2 weeks prior to starting TPO-RA was 88.7×109/L, from 2-4 weeks after TPO-RA was 99×109/L and at 3-4 months was 97×109/L. The overall response (OR) rates at 3-4 months were 72.5%; at 6-7 months were 72% and at 1-2 years were 70%.
Bleeding events were reduced amongst all groups following TPO-RA treatment. In the year prior to starting TPO-RA there were 316 muco-cutaneous bleed events and 82 organ bleeds, in the year after there were 193 and 40, respectively.
Cardiovascular (CV) risk factors before ITP diagnoses are shown in table 2. Over 50% had at least one risk factor for CV disease. Before / after TPO-RA there were 60 and 17 arterial thrombotic events (ATE); 18 and 17 venous thrombotic events (VTE), respectively.
Conclusion(s): This data confirms efficacy of TPO-RA in this group with comparable response rates to the literature based on platelet count response. There does not appear to be an increase in reported thrombotic events after therapy in this group, despite a large number of co-morbidities.
To cite this abstract in AMA style:
Raheja P, Miah H, Miah A, Taylor L, Biss T, Evans G, Scully M, Hermans J, Marshall S, Kilner M, Rayment R, Robinson L, Johns S, Rinaldi C, Jackson H, Ackroyd S, Newland A, Provan D, Cooper N, McDonald V. Thrombopoietin receptor agonists (TPO-RAs) in older patients with primary immune thrombocytopenia (ITP): effective and safe? Real World Data from the UK adult ITP registry. [abstract]. https://abstracts.isth.org/abstract/thrombopoietin-receptor-agonists-tpo-ras-in-older-patients-with-primary-immune-thrombocytopenia-itp-effective-and-safe-real-world-data-from-the-uk-adult-itp-registry/. Accessed September 22, 2023.« Back to ISTH 2022 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/thrombopoietin-receptor-agonists-tpo-ras-in-older-patients-with-primary-immune-thrombocytopenia-itp-effective-and-safe-real-world-data-from-the-uk-adult-itp-registry/