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Routine clinical care for chronic immune thrombocytopenia purpura in Denmark, 2009-2015
Anne Gulbech Ording1, Nickolaj Risbo Kristensen1, Henrik Frederiksen1,2
1Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Insights
Nearly half of chronic immune thrombocytopenia (ITP) patients received treatment before chronic diagnosis, with corticosteroids, IVIG, and rituximab being common choices. Continuous follow-up is crucial as some patients may require treatment later.
Area of Science:
- Hematology
- Immunology
- Epidemiology
Background:
- Chronic immune thrombocytopenia (cITP) management varies, necessitating an understanding of routine clinical care and patient characteristics.
- This study examines treatment patterns and clinical features of cITP patients in Denmark using nationwide data.
Observation:
- Data from 964 Danish cITP patients diagnosed between 2009-2015 were analyzed.
- Nearly half of patients initiated treatment between initial ITP diagnosis and chronic onset.
- Among treatment-naïve patients, 9.2% commenced therapy within one year post-diagnosis.
Findings:
- Corticosteroids (43%), IVIG (12%), and rituximab (18%) were frequently used treatments before chronic onset.
- Corticosteroids and rituximab were common initial therapies for treatment-naïve patients.
- Bleeding events occurred in approximately one-third of treated patients pre-diagnosis and 5% of treatment-naïve patients.
Implications:
- Corticosteroids, IVIG, and rituximab are established first-line treatments for cITP.
- A significant portion of cITP patients may not require immediate treatment, but ongoing monitoring is essential due to potential disease progression.
- Findings align with international studies, suggesting common treatment trends in cITP management.
Abstract:
Objectives: To describe routine treatment and clinical characteristics of patients with chronic ITP (cITP).Methods: We used data from Danish nationwide registers and medical records to examine routine clinical care, including splenectomy and medical treatment, of Danish patients with chronic immune thrombocytopenia (cITP, defined as two or more ITP diagnoses at least 6 months apart), i.e. treatment initiation before cITP diagnosis and treatment initiation within one year post-diagnosis for treatment-naïve patients.Results: Nearly half of all 964 cITP patients diagnosed during 2009-2015 initiated treatment between initial ITP diagnosis and chronic onset; 43% received glucocorticoids, 12% received IVIG and 18% received rituximab. Within one year post-diagnosis, 9.2% of previously untreated patients commenced therapy, most often corticosteroids and rituximab.Discussion: Our results are in line with findings of recent studies from other countries.Conclusion: We found that corticosteroids, IVIG, and rituximab are common first- choice of ITP drugs. Bleeding events occurred in nearly one third of treated patients in the year before cITP diagnosis and in 5% of the treatment-naïve patients. A substantial number of patients do not need treatment during the first 6-12 months. However, some of these patients will subsequently need treatment as the disease may worsen, indicating the need for continuous follow-up of these patients.
