Anti‐CD20 therapeutic options in immune‐mediated thrombotic thrombocytopenic purpura

Abstract

Summary Immunosuppression with rituximab in immune‐mediated thrombotic thrombocytopenic purpura helps decrease production of autoantibody mediating ADAMTS13 clearance from circulation. Failure to respond to rituximab in a satisfactory way or made difficult by adverse events to the medication does not represent a reason to stop considering anti‐CD20 therapies to control antibody production. Therefore, both of atumumab and obinutuzumab with specificity to CD20, represent potentially valuable therapeutic tools in patients who are not candidates for rituximab. Commentary on: Doyle et al. The use of obinutuzumab and ofatumumab in the treatment of immune thrombotic thrombocytopenic purpura. Br J Haematol. 2022;198:391‐396.1

A multicenter evaluation of the Technoscreen ADAMTS13 activity semi‐quantitative screening test for thrombotic thrombocytopenic purpura diagnosis and exclusion

“…1 Diagnostic confirmation also allows use of adjunctive therapies, including multi-modal immunosuppression or targeted therapy (e.g., caplacizumab if available). 10,11,24,25 Similarly, where ADAMTS13 results indicate alternative diagnoses, initiation of more effective targeted therapy (e.g., eculizumab for atypical hemolytic uremic syndrome) could be delayed. 26 Empiric TPE exposes patients to risk of iatrogenic harm, potentially unnecessary if TTP is excluded.…”

“…Inexperienced centers may be reluctant to commence therapy, with one report indicating TPE delay ≥48 h from presentation in 15% of cases 1 . Diagnostic confirmation also allows use of adjunctive therapies, including multi‐modal immunosuppression or targeted therapy (e.g., caplacizumab if available) 10,11,24,25 . Similarly, where ADAMTS13 results indicate alternative diagnoses, initiation of more effective targeted therapy (e.g., eculizumab for atypical hemolytic uremic syndrome) could be delayed 26 .…”