A real‐world study of immune thrombocytopenia management during the COVID‐19 pandemic in the UK

Abstract

Summary The COVID‐19 pandemic has created many challenges in the management of immune thrombocytopenic purpura (ITP). The recommendation for avoidance of steroids by WHO led to the off‐licence use, supported by NHS England, of thrombopoietin mimetics (TPO‐RA) for newly diagnosed or relapsed ITP. This is a real‐world prospective study which investigated the treatment patterns and outcomes in this setting. Twenty‐four hospitals across the UK submitted 343 cases. Corticosteroids remain the mainstay of ITP treatment, but TPO‐RAs were more effective. Incidental COVID‐19 infection was identified in a significant number of patients (9·5%), while 14 cases were thought to be secondary to COVID‐19 vaccination.

Impact of COVID-19 Infection, Vaccination, and Serological Response in Immune Thrombocytopenic Purpura Patients: A Single-Center Global Analysis

“…Infections are one of the well-known precipitating factors for relapses and exacerbations in pts with ITP. Very few studies focusing on the effect of COVID-19 infection in chronic ITP patients have been published [ 5 , 6 , 7 , 8 , 9 , 20 , 21 ] with divergent conclusions and an unclear distinction between de novo ITP and previous/chronic ITP. One of the largest studies [ 7 ] reported the outcome of 32 pts with a pre-existing ITP with COVID-19 infection reporting a reduction in plt count in 47% of the pts, all requiring treatment or a modification of current ITP treatment.…”

“…The current SARS-CoV-2 (COVID-19) pandemic is characterized by severe pneumonia, multiorgan disease, and dysregulation of immunity [ 3 , 4 ]. De novo and exacerbation of autoimmune phenomena have been described both after COVID-19 infection [ 5 , 6 , 7 , 8 , 9 ] and vaccination [ 5 , 10 , 11 , 12 , 13 , 14 ], one of the most effective weapons to control disease [ 15 ]. Considering vaccination and ITP, so far, the relationship has not been well-characterized, and some data are still a matter of debate [ 16 , 17 ].…”

COVID-19-induced immune thrombocytopenic purpura; Immunopathogenesis and clinical implications

“…Combination therapy with systemic steroids and monoclonal antibodies (such as rituximab) is recommended as the main treatment option in patients with COV-ID-19-associated ITP [55]. Studies have reported that patients with ITP or those receiving steroids have a risk for thrombosis [56]. In addition, there is a risk of thrombosis in patients with COVID-19.…”

“…They also reported that TPO-RAs are highly effective either as the first-line or additional treatment option. Moreover, patients receiving TPO-RAs showed lower rates of thrombosis compared to patients treated with steroids or without any treatment [56]. The treatment options in COVID-19-induced ITP are shown in Table 1.…”

Púrpura Trombocitopênica Idiopática secundária à infecção por Covid-19: uma revisão integrativa

“…No entanto, a Organização Mundial da Saúde (OMS) desaconselhou o uso de corticosteróides sempre que possível durante este período, pois eles podem aumentar o risco de maior severidade da Covid-19 e a gravidade da doença. Recentemente no Reino Unido, recomendou-se o uso de agonistas do receptor de trombopoietina como tratamento de primeira linha em pacientes que apresentam recaída de PTI durante este período e o Serviço Nacional de Saúde da Inglaterra apoiou este uso off-label de forma rápida e provisória (RAMPOTAS A, et al, 2021).…”