2021 Chinese consensus on the diagnosis and management of primary immune thrombocytopenia in pregnancy

Zhang, Xiaohui; Chen, Fangping; Chen, Xiequn; Cheng, Yunfeng; Fang, Meiyun; Feng, Jianming; Fu, Hai-Xia; Gao, Hong; Han, Yue; He, Anbang; Hou, Ming; Hu, Yao; Huang, Ruibin; Huang, Wenrong; Jing, Z C; Kong, Peiyan; Liang, Aibin; Liang, Mei-Ying; Liu, Dai‐Hong; Liu, Junling; Liu, Lin; Liu, Xiaowei; Ma, Liangming; Mei, Heng; Ni, Heyu; Niu, Ting; Peng, Jun; Qiao, Jianlin; Ren, Jinhai; Song, Yongping; Tang, Liang V.; Tong, Tong; Wang, Shaoyuan; Wang, Xin; Wang, Zhao; Wei, Hui; Wu, Depei; Wu, Guangsheng; Xu, Caigang; Xue, Xiangxin; Xu, Yuesheng; Yang, Lianjuan; Yang, Renchi; Yang, Tao; Yin, Chenghong; Yu, Li; Zhang, Guangsen; Zhang, Lei; Zhang, Liansheng; Zhang, Xi; Zhao, Weili; Zhao, Yongqiang; Zhou, Daobin; Zhou, Hu; Zhou, Zeping; Tie-nan, Zhu; Wang, Jianliu; Huang, Xiao‐Jun

doi:10.1097/cm9.0000000000002043

Cited by 3 publications

(5 citation statements)

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“…Clinical data (including age, gender, comorbidities, bleeding symptoms, baseline platelet counts, megakaryocyte counts, lymphocyte subsets, quantitation of immunoglobulins, treatment regimen, platelet counts, and adverse events) were recorded for analysis. The bleeding manifestation was evaluated by an ITP bleeding scale recommended in a consensus of Chinese experts on the diagnosis and treatment of adult ITP by the Chinese Medical Association [ 5 , 20 ]. This scale showed strong assessment consistency and close correlation with the ITP-specific bleeding assessment tool (ITP-BAT), while having less time-consuming calculation.…”

Section: Methodsmentioning

confidence: 99%

“…Wang et al conducted a multicenter randomized controlled trial in 2012, showing that platelet counts in patients with chronic ITP increase rapidly after rhTPO treatment [ 19 ]. Other studies have also demonstrated that rhTPO with/without glucocorticoid could both rapidly increase platelet counts and improve the complete response rate in severe newly diagnosed ITP [ 20 ], ITP with pregnancies [ 14 , 21 ], and corticosteroid-resistant/relapsed ITP [ 22 ]. Similarly, it is worth mentioning that a prospective, randomized, controlled clinical trial conducted by Hou suggested that the combination of high-dose dexamethasone with rhTPO could remarkably improve the initial and sustained response, strongly supporting the efficacy of rhTPO as a potential frontline treatment for newly diagnosed adult ITP [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Recombinant Thrombopoietin Effectively Shortens the Time to Response and Increases Platelet Counts in Elderly Patients with Severe Immune Thrombocytopenia

Sun

et al. 2022

JCM

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Background: This study was conducted to investigate the short-term efficacy and safety of rhTPO for the management of severe ITP in the elderly as first-line treatment. Methods: A total of 54 elderly patients with severe ITP were studied, including 39 patients treated with a combination regimen of rhTPO plus standard treatment (glucocorticoid; rhTPO group) and 15 patients treated with glucocorticoid treatment alone (control group). The response rate, time to initial response, peak platelet counts, and time to peak platelet counts were compared, and clinical characteristics correlated with the efficacy of rhTPO were analyzed. The efficacy of rhTPO in the elderly is comparable to the non-elderly in terms of the OR, CR, time to initial response, and peak platelet counts. Results: There were no differences in the overall response (OR) and the complete response (CR) in the rhTPO group compared to the control group. The time to initial response in the rhTPO group was shorter than that in the control group (p = 0.032). In patients without intravenous immunoglobulin (IVIg) and platelet transfusion, the peak platelet counts in the rhTPO group were higher than those in the control group (p = 0.003). Conclusions: Standard glucocorticoid treatment plus rhTPO effectively shortens the time to response and increases platelet counts in the elderly with severe ITP.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Recombinant Thrombopoietin Effectively Shortens the Time to Response and Increases Platelet Counts in Elderly Patients with Severe Immune Thrombocytopenia

Sun

et al. 2022

JCM

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“…Present clinical practice mainly refers to guidelines for the management of immune thrombocytopenia. [ 71 , 72 ] Glucocorticoids and IVIG can be used as first-line therapy. Specifically, IVIG is recommended at a dose of 400 mg·kg -1 ·d -1 for 3 to 5 days, with the option of repeating the treatment after 1 to 2 weeks if necessary.…”

Section: Management Of Flares or Aggravation In Sle Patients During P...mentioning

confidence: 99%

2022 Chinese guideline for the management of pregnancy and reproduction in systemic lupus erythematosus

Tian,

Zhao,

Song

et al. 2023

Rheumatology and Immunology Research

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Systemic lupus erythematosus (SLE), a prevalent autoimmune disease predominantly affecting women of childbearing age, presents ongoing challenges despite notable advances in diagnosis and treatment. Although survival rates for SLE patients have significantly improved, pregnancy continues to pose a considerable obstacle. Addressing this critical need for enhanced reproductive and prenatal care, there is a pressing imperative to establish standardized protocols for peri-gestational monitoring and treatment in SLE patients. This guideline is jointly sponsored by the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), the Chinese Systemic Lupus Erythematosus Treatment and Research Group (CSTAR), and the Chinese Research Committee of Pregnancy and Reproduction in Autoimmune Rheumatic Diseases (CHOPARD). Thirteen pertinent clinical questions have been generated through several rounds of rigorous clinical and methodological expert discussions and selections for a comprehensive understanding of key aspects in this domain. Guided by thorough examination of research evidence and expert perspectives, the formulated recommendations aim to optimize pregnancy success rates, reduce maternal and infant mortality rates, and ultimately enhance the overall well-being of SLE patients.

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“…The median (IQR) maternal age was 30 (25)(26)(27)(28)(29)(30)(31)(32)(33) years, and the mean body mass index (BMI) was 24.5 ± 3.1 kg/ m 2 . Among the patients, forty-seven (58%) were nulliparous and 34 (42%) multiparous.…”

Section: Baseline Characteristicsmentioning

confidence: 99%

“…TPO-RAs are a small molecule that can cross the placenta and may cause neonatal thrombocytosis [30]. International [6] and Chinese [31] consensuses state that these TPO-RA drugs should be used only in extremely severe cases, when other treatments fail or are not available, and only in the third trimester, as a means to increase platelet counts before delivery. Rituximab can cross the placenta [32], and the response may be slow (up to 8 weeks).…”

Section: Table 4 Outcomes In Rhtpo Groupmentioning

confidence: 99%

Recombinant human thrombopoietin therapy for primary immune thrombocytopenia in pregnancy: a retrospective comparative cohort study

Lin,

Wang,

Huang

et al. 2023

BMC Pregnancy Childbirth

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Background Treatment options for pregnant women with immune thrombocytopenia (ITP) who do not respond to first-line treatment are limited. Few studies have reported the use of recombinant human thrombopoietin (rhTPO) for this subset of patients. Aims To investigate the efficacy and safety of rhTPO in ITP during pregnancy and determine obstetric outcomes and predictors of treatment response. Methods From July 2013 to October 2022, the data of 81 pregnant women with ITP and a platelet count < 30 × 109/L who did not respond to steroids and/or intravenous immunoglobulin were retrospectively analysed. Of these patients, 33 received rhTPO treatment (rhTPO group) while 48 did not (control group). Baseline characteristics, haematological disease outcomes before delivery, obstetric outcomes, and adverse events were compared between groups. In the rhTPO group, a generalised estimating equation (GEE) was used to investigate the factors influencing the response to rhTPO treatment. Results The baseline characteristics were comparable between both groups (P > 0.05, both). Compared with controls, rhTPO patients had higher platelet counts (median [interquartile range]: 42 [21.5–67.5] vs. 25 [19–29] × 109/L, P = 0.002), lower bleeding rate (6.1% vs. 25%, P = 0.027), and lower platelet transfusion rate before delivery (57.6% vs. 97.9%, P < 0.001). Gestational weeks of delivery (37.6 [37–38.4] vs 37.1 [37–37.2] weeks, P = 0.001) were longer in the rhTPO group than in the control group. The rates of caesarean section, postpartum haemorrhage, foetal or neonatal complications, and complication types in both groups were similar (all P > 0.05). No liver or renal function impairment or thrombosis cases were observed in the rhTPO group. GEE analysis revealed that the baseline mean platelet volume (MPV) (odds ratio [OR]: 0.522, P = 0.002) and platelet-to-lymphocyte ratio (PLR) (OR: 1.214, P = 0.025) were predictors of response to rhTPO treatment. Conclusion rhTPO may be an effective and safe treatment option for pregnancies with ITP that do not respond to first-line treatment; it may have slightly prolonged the gestational age of delivery. Patients with a low baseline MPV and high baseline PLR may be more responsive to rhTPO treatment. The present study serves as a foundation for future research.

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2021 Chinese consensus on the diagnosis and management of primary immune thrombocytopenia in pregnancy

Cited by 3 publications

References 0 publications

Recombinant Thrombopoietin Effectively Shortens the Time to Response and Increases Platelet Counts in Elderly Patients with Severe Immune Thrombocytopenia

Recombinant Thrombopoietin Effectively Shortens the Time to Response and Increases Platelet Counts in Elderly Patients with Severe Immune Thrombocytopenia

2022 Chinese guideline for the management of pregnancy and reproduction in systemic lupus erythematosus

Recombinant human thrombopoietin therapy for primary immune thrombocytopenia in pregnancy: a retrospective comparative cohort study

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