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

Abstract

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).

Immune thrombocytopenia in the elderly: immunosenescent and clinical diversity

“…For example, corticosteroids remain an important front-line ITP therapy. Sokal et al 5 report higher than expected response rates to corticosteroids AE IVIg in VEPs and EPs. Yet, corticosteroids can incite or exacerbate problems already associated with ageing, including hypertension, hyperglycaemia, mood disturbances and agitation, and gastrointestinal (GI) bleeding.…”

“…In their paper Sokal et al 5 present data from the Cytop enies Auto-immunes: Registre Midi-Pyr eneEN (CARMEN)-France registry that expand and our understanding of the real-world presentation, risk factors for bleeding, and management of primary ITP in elderly patients (EPs), defined as those aged 65-79 years, as compared with the very EPs (VEPs) aged ≥80 years. The results complement the findings from other large ITP registries that have focussed on EPs and VEPs 6,7 and confirm the expectation that VEPs have a greater number of comorbidities and experience more severe bleeding events and higher mortality compared to younger cohorts.…”

“…Despite the insights provided by the Sokal et al 5 study and other large ITP registries that have examined EPs and VEPs, significant gaps in our knowledge persist. We lack prospective randomised controlled treatment trials for these age cohorts and recognise that elderly adults were typically excluded from clinical registration trials, due to age-related entry criteria, medical comorbidities, and, most important, selection bias exercised by investigators.…”

“…In their paper Sokal et al 5 . present data from the Cytopénies Auto‐immunes: Registre Midi‐PyréneEN (CARMEN)‐France registry that expand and our understanding of the real‐world presentation, risk factors for bleeding, and management of primary ITP in elderly patients (EPs), defined as those aged 65–79 years, as compared with the very EPs (VEPs) aged ≥80 years.…”

“…The success of this approach will require international collaboration. In this spirit, the Sokal et al 5 paper can serve as a 'call to action' for the creation of a single longitudinal, international registry, employing standardised definitions of diagnosis and safety and efficacy, and this effort should be combined with a biorepository to study the immunoregulation of ITP in all age cohorts. This aspirational endeavour offers the potential to understand real-world primary ITP versus 'masked' secondary ITP in the elderly.…”