A decade of changes in management of immune thrombocytopenia, with special focus on elderly patients
Por:
Lozano, M, Mingot-Castellano, M, Perera, M, Jarque, I, Campos-Alvarez, R, Gonzalez-Lopez, T, Carreno-Tarragona, G, Bermejo, N, Lopez-Fernandez, M, de Andres, A, Valcarcel, D, Casado-Montero, L, Alvarez-Roman, M, Orts, M, Novelli, S, Gonzalez-Porras, J, Bolanos, E, Lopez-Ansoar, E, Orna-Montero, E and Vicente, V
Publicada:
1 feb 2021
Resumen:
Background: Ten years after their availability, thrombopoietin receptor agonists (TPO-RA) have heralded a paradigm shift in the treatment of immune thrombocytopenia (ITP). This study was aimed to analyze the implementation of current recommendations in the standard practice of adult ITP patients, and how age may influence those changes.
Methods: We included 121 adult patients (> 65 years, n = 54; younger individuals, n = 67) who initiated treatment with TPO-RA between January 2012 and December 2014.
Results: Patients older than 65 years treated with TPO-RA presented at diagnosis with significantly higher platelet counts, less bleeding, and a more prothrombotic profile than younger ones. The high efficacy rates of TPO-RA, preferentially used during the last decade in non-chronic phases, precluded from further therapies in the majority of ITP patients. Their administration was associated with a sharp decline in the last decade in the use of splenectomy and intravenous immunoglobulin, especially in younger ITP individuals.
Conclusion: These results confirm (1) that there is a preferential use of TPO-RAs in elderly ITP patients with fewer bleeding complications but more unfavorable prothrombotic conditions than in younger individuals, and (2) that early use of these agents has been established as an effective therapeutic alternative to other second line therapies.
Filiaciones:
Lozano, M:
Univ Murcia, IMIB Arrixaca, Hosp Univ Morales Meseguer, Ctr Reg Hemodonac, CB15-00055 CIBERER, Murcia, Spain
Mingot-Castellano, M:
Hosp Univ Virgen Rocio, Hosp Carlos Haya, Seville, Spain
Perera, M:
Hosp Univ Gran Canaria Dr Negrin, Las Palmas Gran Canaria, Spain
Jarque, I:
Hosp Univ & Politecn La Fe, Valencia, Spain
Campos-Alvarez, R:
Hosp Especial Jerez De La Frontera, Cadiz, Spain
Gonzalez-Lopez, T:
Hosp Univ Burgos, Burgos, Spain
Carreno-Tarragona, G:
Hosp 12 Octubre, Madrid, Spain
Bermejo, N:
Hosp San Pedro de Alcantara, Caceres, Spain
Lopez-Fernandez, M:
Complejo Hosp Univ A Coruna, La Coruna, Spain
de Andres, A:
Complexo Hosp Univ Santiago, La Coruna, Spain
Valcarcel, D:
Univ Hosp Vall Hebron, Vall Hebron Inst Oncol VHIO, Barcelona, Spain
Casado-Montero, L:
Hosp Virgen Salud, Toledo, Spain
Alvarez-Roman, M:
Hosp Univ La Paz IdiPAZ, Madrid, Spain
:
Hosp Sagunto, Valencia, Spain
Novelli, S:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Gonzalez-Porras, J:
Hosp Univ Salamanca HUSAL IBSAL, Salamanca, Spain
USAL, CSIC, IBMCC, Salamanca, Spain
Bolanos, E:
Hosp Clin San Carlos, Madrid, Spain
Lopez-Ansoar, E:
Hosp Alvaro Cunqueiro, Pontevedra, Spain
Orna-Montero, E:
Hosp Badalona Germans Trias & Pujol, Inst Catala Oncol, Badalona, Spain
Vicente, V:
Univ Murcia, IMIB Arrixaca, Hosp Univ Morales Meseguer, Ctr Reg Hemodonac, CB15-00055 CIBERER, Murcia, Spain
Green Published, hybrid
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