TY - JOUR
T1 - Real-world use of thrombopoietin receptor agonists in elderly patients with primary immune thrombocytopenia
AU - Palandri, Francesca
AU - Rossi, Elena
AU - Bartoletti, Daniela
AU - Ferretti, Antonietta
AU - Ruggeri, Marco
AU - Lucchini, Elisa
AU - Carrai, Valentina
AU - Barcellini, Wilma
AU - Patriarca, Andrea
AU - Rivolti, Elena
AU - Consoli, Ugo
AU - Cantoni, Silvia
AU - Oliva, Esther Natalie
AU - Chiurazzi, Federico
AU - Caocci, Giovanni
AU - Giuffrida, Gaetano
AU - Borchiellini, Alessandra
AU - Auteri, Giuseppe
AU - Baldacci, Erminia
AU - Carli, Giuseppe
AU - Nicolosi, Daniela
AU - Sutto, Emanuele
AU - Carpenedo, Monica
AU - Cavo, Michele
AU - Mazzucconi, Maria Gabriella
AU - Zaja, Francesco
AU - De Stefano, Valerio
AU - Rodeghiero, Francesco
AU - Vianelli, Nicola
PY - 2021
Y1 - 2021
N2 - The efficacy and safety of thrombopoietin-receptor agonists (TRAs) in elderly patients with primary immune thrombocytopenia (ITP) is uncertain. In 384 ITP patients treated with TRAs when aged ≥60 years, we investigated TRAs response and switch, thrombotic/hemorrhagic risk, and sustained responses off-treatment (SROT). After 3 months, 82.5% and 74.3% of eltrombopag and romiplostim-treated patients achieved a response, respectively (p=0.09); 66.7% maintained the response (median follow-up: 2.7 years). Eighty-five (22.2%) patients switched to the alternative TRA; while no cross-toxicity was observed, 83.3% of resistant patients had a response after the switch. During TRA, 34 major thromboses (3 fatal) and 14 major hemorrhages (none fatal) occurred in 18 and 10 patients, respectively, and were associated with thrombosis history (SHR: 2.04, p=0.05) and platelet count <20x109/L at TRA start (SHR: 1.69, p=0.04), respectively. A recurrent event occurred in 15.6% of patients surviving thrombosis, in all cases but one during persisting TRA treatment (incidence rate: 7.7 per 100 patient-years). All recurrences occurred in the absence of adequate antithrombotic secondary prophylaxis. Sixty-two (16.5%) responding patients discontinued TRA; 53 (13.8%) patients maintained SROT, which was associated with TRA discontinuation in complete response (p<0.001). Very old age (≥75, 41.1%) was associated with more frequent TRAs start in persistent/acute phase but not with response or thrombotic/hemorrhagic risk. TRAs are effective in elderly ITP patients, with no fatal haemorrhages and with SROT in a significant portion of patients; in patients with thrombosis history caution is warranted and a careful risk/benefit balance should be carried out.
AB - The efficacy and safety of thrombopoietin-receptor agonists (TRAs) in elderly patients with primary immune thrombocytopenia (ITP) is uncertain. In 384 ITP patients treated with TRAs when aged ≥60 years, we investigated TRAs response and switch, thrombotic/hemorrhagic risk, and sustained responses off-treatment (SROT). After 3 months, 82.5% and 74.3% of eltrombopag and romiplostim-treated patients achieved a response, respectively (p=0.09); 66.7% maintained the response (median follow-up: 2.7 years). Eighty-five (22.2%) patients switched to the alternative TRA; while no cross-toxicity was observed, 83.3% of resistant patients had a response after the switch. During TRA, 34 major thromboses (3 fatal) and 14 major hemorrhages (none fatal) occurred in 18 and 10 patients, respectively, and were associated with thrombosis history (SHR: 2.04, p=0.05) and platelet count <20x109/L at TRA start (SHR: 1.69, p=0.04), respectively. A recurrent event occurred in 15.6% of patients surviving thrombosis, in all cases but one during persisting TRA treatment (incidence rate: 7.7 per 100 patient-years). All recurrences occurred in the absence of adequate antithrombotic secondary prophylaxis. Sixty-two (16.5%) responding patients discontinued TRA; 53 (13.8%) patients maintained SROT, which was associated with TRA discontinuation in complete response (p<0.001). Very old age (≥75, 41.1%) was associated with more frequent TRAs start in persistent/acute phase but not with response or thrombotic/hemorrhagic risk. TRAs are effective in elderly ITP patients, with no fatal haemorrhages and with SROT in a significant portion of patients; in patients with thrombosis history caution is warranted and a careful risk/benefit balance should be carried out.
KW - Immune Thrombocytopenia
KW - Immune Thrombocytopenia
UR - https://publicatt.unicatt.it/handle/10807/178881
UR - https://www.scopus.com/inward/citedby.uri?partnerID=HzOxMe3b&scp=85113182142&origin=inward
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85113182142&origin=inward
U2 - 10.1182/blood.2021010735
DO - 10.1182/blood.2021010735
M3 - Article
SN - 0006-4971
SP - N/A-N/A/A
JO - Blood
JF - Blood
IS - N/A
ER -