Management of elderly patients with immune thrombocytopenia: Real-world evidence from 451 patients older than 60 years

Palandri, Francesca; Santoro, Cristina; Carpenedo, Monica; Cantoni, Silvia; Barcellini, Wilma; Carli, Giuseppe; Carrai, Valentina; Rossi, Elena; Rivolti, Elena; Lucchesi, Alessandro; Rotondo, Francesco; Baldacci, Erminia; Auteri, Giuseppe; Sutto, Emanuele; Pietro, Christian Di; Catani, Lucia; Bartoletti, Daniela; Stefano, Valerio De; Ruggeri, Marco; Mazzucconi, Maria Gabriella; Cavo, Michèle; Rodeghiero, Francesco; Vianelli, Nicola

doi:10.1016/j.thromres.2019.11.026

Cited by 8 publications

(21 citation statements)

References 28 publications

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“…With the aim to look for differences regarding patient characteristics and following the scheme of previous publications, 26,27 we divided our whole patient populations in two different cohorts: 65-to 74-year-old and 75-and-above-year-old ITP patients. Unfortunately, no statistical differences were found between groups (Table 3).…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…Nevertheless, in last years good few studies regarding eltrombopag use in primary ITP beyond clinical trials were published [17][18][19] and increasing number of papers is available for elderly situations. [20][21][22][23][24][25][26][27] Regarding secondary ITP, lack of clinical trials and shortage of publications outside of clinical trials avoid a clear demonstration of eltrombopag usefulness for this type of patients. 28,29 The aim of our present study is to evaluate safety and efficacy of eltrombopag for primary and secondary ITP in patients aged ≥65 years in Spanish routine clinical practice.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, Italian group reports higher thrombosis incidence in the elderly 26. Furthermore, some studies suggest TPO-RA use predisposes to thrombosis,22 while other publications do not find that association 40 even in elderly populations 27. Recently, Wong et al16 reported EXTEND study results with 19 chronic primary ITP patients (6%) who experienced thrombotic events.…”

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confidence: 99%

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Use of eltrombopag for patients 65 years old or older with immune thrombocytopenia

González-López

Sánchez‐González

Jarque

et al. 2020

European J of Haematology

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Background Eltrombopag is useful for immune thrombocytopenia (ITP). However, results of clinical trials may not accurately mirror clinical practice reality. Here we evaluated eltrombopag for primary and secondary ITP in our ≥65‐year‐old population. Methods A total of 106 primary ITP patients (16 with newly diagnosed ITP, 16 with persistent ITP, and 74 with chronic ITP) and 39 secondary ITP patients (20 with ITP secondary to immune disorders, 7 with ITP secondary to infectious diseases, and 12 with ITP secondary to lymphoproliferative disorders [LPD]) were retrospectively evaluated. Results Median age of our cohort was 76 (interquartile range, IQR, 70‐81) years. 75.9% of patients yielded a platelet response including 66.2% complete responders. Median time to platelet response was 14 (IQR, 8‐21) days. Median time on response was 320 (IQR, 147‐526) days. Sixty‐three adverse events (AEs), mainly grade 1‐2, occurred. The most common were hepatobiliary laboratory abnormalities (HBLAs) and headaches. One transient ischemic attack in a newly diagnosed ITP and two self‐limited pulmonary embolisms in secondary ITP were the only thrombotic events observed. Conclusion Eltrombopag showed efficacy and safety in ITP patients aged ≥65 years with primary and secondary ITP. However, efficacy results in LPD‐ITP were poor. A relatively high number of deaths were observed.

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Section: Patient Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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Use of eltrombopag for patients 65 years old or older with immune thrombocytopenia

González-López

Sánchez‐González

Jarque

et al. 2020

European J of Haematology

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“…3,7,[9][10][11][12][13][14][15][16][17][18][19][20] Data are even scarcer in very elderly patients (VEPs): only one recent study focussed on this subgroup. 20 In this retrospective study, patients aged ≥75 years had not more frequent bleeding (including severe bleeding) at initial presentation; response to first-line treatment did not differ from younger patients, but thrombopoietin receptor agonists (TPORAs) and immunosuppressive drugs were more frequently used as second-line treatments. These results highlight the need for further characterisation of ITP in VEPs using a prospective cohort.…”

Section: Introductionmentioning

confidence: 99%

“…Although controversial between studies, older age may impact ITP management, and these aged patients seem to experience more ITP‐related outcomes, including a higher frequency of serious bleeding. However, the risk factors associated with this burden are poorly known, including the platelet count threshold associated with bleeding 3,7,9–20 …”

Section: Introductionmentioning

confidence: 99%

Primary immune thrombocytopenia in very elderly patients: particularities in presentation and management: results from the prospective CARMEN‐France Registry

et al. 2021

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Data about the presentation and the management of primary immune thrombocytopenia (ITP) in very elderly patients (VEPs; aged ≥80 years) are lacking. The aim of the present study was to describe ITP in this subgroup. The data source was the prospective CARMEN-France registry. Patients included between 2013 and 2018 were selected. ITP presentation and management in VEPs was compared to elderly patients (EPs; aged 65-79 years). We assessed factors associated with bleeding at ITP onset in VEPs. Of 541 patients, 184 were included: 87 in the VEP group and 97 in the EP group. The mean age was 85Á7 years in the VEP group. Comorbidities were more frequent in the VEP group (67Á4% vs. 47Á9%). The median platelet count at ITP onset was similar but severe bleeding tended to be more frequent in VEPs (10Á3% vs. 4Á1%, P = 0Á1) as well as mortality. Exposure to ITP drugs, response to first-line treatment, need of second-line treatment, evolution towards persistency, occurrence of bleeding, infection and thrombosis did not differ between groups. In VEPs, factors associated to bleeding were female sex [odds ratio (OR) 4Á75, 95% confidence interval (CI) 1Á31-17Á32] and platelet count of <20 9 10 9 /l (OR 10Á05, 95% CI 4Á83-67Á39). Exposure to anticoagulants was strongly associated with severe bleeding (OR 7Á61, 95% CI 1Á77-32Á83).

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Risk of infection in adult patients with primary immune thrombocytopenia (ITP): a systematic review

Sandvad

Pedersen

Frederiksen

et al. 2021

Expert Review of Hematology

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Introduction: Primary immune thrombocytopenia (ITP) is a bleeding disorder characterized by autoimmune destruction and impaired production of platelets. Immunosuppressive drugs are the main treatment and may increase risk of infection.Areas covered: This systematic review included studies incorporating adult patients with primary ITP and infectious outcomes. Studies comparing risk of infection with the general population were included as primary and studies without this comparison were considered secondary. Three primary and ten secondary studies were included. The main findings: 1-year adjusted relativerisk of infection was 4.5 (95% CI, 3.3 -6.1) fold elevated compared to the general population. When comparing splenectomized with non-splenectomized ITP patients, the +1-year adjusted relative-risk of infection was 4.0 (95% CI, 2.8 -5.6). The unadjusted 5-year mortality rate-ratio for infectionrelated deaths was 6.0 (95% CI, 3.0 -11.8) in one study, and the hazard ratio was 2.4 (95% CI, 1.0 -5.7) for fatal infections in another.Expert opinion: This review emphasizes that patients with ITP have increased risk of infection.Since ITP is a benign hematologic disease, it is important to assess the extent and causes of infection in the clinical care and considerations before initiating treatment. More homogeneous studies are needed on this topic.

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Management of elderly patients with immune thrombocytopenia: Real-world evidence from 451 patients older than 60 years

Cited by 8 publications

References 28 publications

Use of eltrombopag for patients 65 years old or older with immune thrombocytopenia

Use of eltrombopag for patients 65 years old or older with immune thrombocytopenia

Primary immune thrombocytopenia in very elderly patients: particularities in presentation and management: results from the prospective CARMEN‐France Registry

Risk of infection in adult patients with primary immune thrombocytopenia (ITP): a systematic review

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