[ITP changes because of you] Issue 38

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^{The clinical goal of} ITP therapy is to resolve bleeding events or prevent severe bleeding by providing adequate hemostasis

The results of research analysis showed that about 30% of patients did not get the initial response after hormone therapy4, and 70% to 90% of patients would relapse after hormone therapy was ^{reduced or} stopped .

The Chinese Guidelines for the Diagnosis and Treatment of Primary Immune Thrombocytopenia in Adults (2020 Edition) ¹ states:

① Patients who are ineffective or relapsed after high-dose dexamethasone treatment can be repeated for 1 cycle (1 cycle of 4 days), and patients who are ineffective in prednisone treatment within 2 weeks should be stopped as soon as possible;

② Patients with advanced age, diabetes, hypertension, glaucoma, etc.

③ The dose of prednisone should be reduced as soon as possible after the onset of effect, and discontinued within 6 to 8 weeks.

Let us hear the experts' opinions on the treatment goals of ITP patients and the unmet need for first-line hormone therapy

Professor Liang Xinglin

• Master of Medicine, Deputy Chief Physician, Department of Hematology, First Affiliated Hospital of Anhui Medical University

• Secretary of Hematology Branch of Anhui General Practitioners Association

• Member of the Hematology Branch of Anhui Geriatrics Association

• He has been engaged in the clinical practice of hematology for more than ten years, and is good at the diagnosis and treatment of leukemia, lymphoma, myeloma, hematopoietic stem cell transplantation, allergic purpura and other hematological diseases

Gender: Female

Age: 52

Initial platelet level: 9×10 ⁹ /L 

Hormone insufficiency: Hormone ineffective

The specific medication regimen and medication duration of the previous case (before the use of second-line drugs):

Drug name and dosage: Dexamethasone 40mg

Duration of medication: 1 week

Table 1 Case 1 follow-up and efficacy evaluation records

Note: Both corticosteroids and eltrombopag are administered once daily (qd)

Figure 1 Follow-up and efficacy evaluation records of case 1

The patient's initial platelet count was 9 × 10 ⁹ /L, and after 11 weeks of eltrombopag treatment, the platelet count increased to 157 × 10 ⁹ /L, achieving a complete response, that is, platelet count ≥ 100 × 10 ⁹ /L, and no bleeding
.

Professor Wen Huiting

• Resident Physician in Donggang District, First Hospital of Lanzhou University

• 6 years of experience in hematology

• Good at diagnosis and treatment of common diseases in hematology

• Long-term participation in allogeneic hematopoietic stem cell transplantation

Regarding the treatment goals of ITP patients, Professor Wen Huiting believes: "The treatment goals of ITP patients are to increase the patient's platelet count to a safe range, reduce the risk of bleeding, prevent bleeding, reduce adverse drug reactions, and improve anxiety
.

"

Case 2 basic information:

Sex: Male

Age: 61 

Initial platelet level: 14×10 ⁹ /L

Hormone insufficiency: Hormone intolerance

The specific medication regimen and medication duration of the previous case (before the use of second-line drugs):

Drug name and dosage: Dexamethasone 40mg qd

Duration of medication: 2 weeks

Table 2 Case 2 follow-up and efficacy evaluation records

Note: Both corticosteroids and eltrombopag are administered once daily (qd)
.

Figure 2 Follow-up and efficacy evaluation records of case 2

The patient's initial platelet count was 14 × 10 ⁹ /L, and after 11 weeks of eltrombopag treatment, the platelet count increased to 109 × 10 ⁹ /L, achieving a complete response, that is, platelet count ≥ 100 × 10 ⁹ /L, and no bleeding
.

Professor Han Xiaoping

• Associate Professor, Deputy Chief Physician, Department of Hematology, First Medical Center, PLA General Hospital

• He graduated from the Fourth Military Medical University

• For a long time, he has been engaged in front-line clinical work, and has accumulated rich clinical practical work experience in the diagnosis and treatment of hematological malignant tumors and the treatment of complications.
  

• In recent years, the focus of work is the diagnosis and treatment of myeloproliferative diseases and chronic blood diseases

Regarding the treatment goals of ITP patients, Professor Han Xiaoping believes: "The treatment goals of ITP patients are to reduce the adverse reactions of drugs, reduce the risk of bleeding, and improve the quality of life of patients
.

"

Case 3 basic information:

Sex: Male

Age: 90

Initial platelet level: 23×10 ⁹ /L 

Hormone Poor Situation: Hormone Dependence

The specific medication regimen and medication duration of the previous case (before the use of second-line drugs):

Drug name and dosage: Dexamethasone 40mg qd

Duration of medication: 3 weeks

Table 3 Case 3 follow-up and efficacy evaluation records

Note: Both corticosteroids and eltrombopag are administered once daily (qd)
.

Figure 3 Follow-up and efficacy evaluation records of case 3

The patient's initial platelet count was 23 × 10 ⁹ /L, and after 9 weeks of eltrombopag (25 mg, qd) treatment, the platelet count increased to 124 × 10 ⁹ /L, achieving a complete response, that is, platelet count ≥ 100 × 10 ⁹ /L, and no bleeding
.

Professor Xie Yanyan

• Attending Physician of North China University of Science and Technology Affiliated Hospital Member of the Communist Party of China

• Graduated from North China University of Technology in 2016, majoring in clinical medicine

• Responsible for the database management of Tangshan Hemophilia Center

• He is also a member of the Thrombosis and Hemostasis Group Committee of the Chinese Medical Association

• Member of Hematology Professional Committee of Hebei Association of Integrative Medicine

• Published 7 articles as the first author and 4 articles in the Chinese series of magazines

• Presided over 2 city-level projects, participated in 4 provincial and ministerial-level projects, and participated in the publication of 1 monograph

Regarding the unmet needs of first-line hormone therapy for ITP, Professor Xie Yanyan believes: "The adverse reactions of first-line hormone therapy are relatively large
.

"

Case 4 Basic information:

Sex: Male

Age: 59

Initial platelet level: 1×10 ⁹ /L

Hormone Poor Situation: Hormone Dependence

The specific medication regimen and medication duration of the previous case (before the use of second-line drugs):

Drug name and dosage: Prednisone 10 tablets qd

Duration of medication: 8 weeks 

Table 4 Case 4 follow-up and efficacy evaluation records

Note: Eltrombopag is administered once daily (qd)
.

Figure 4 Follow-up and efficacy evaluation records of case 4

The patient's initial platelet count was 1 × 10 ⁹ /L, and after 8 weeks of eltrombopag treatment, the platelet count increased to 126 × 10 ⁹ /L, achieving a complete response, that is, platelet count ≥ 100 × 10 ⁹ /L, and no bleeding
.

references

1.
Hou Ming, Hu Yu.
Chinese Journal of Hematology, 2020(8):617-623.

2.
Frederiksen, H.
et al.
Blood.
1999;94:909-913.

3.
Provan, D.
et al.
Blood Adv.
2019;3:3780-3817.

4.
Cuker A, et al.
Res Pract Thromb Haemost.
2021;5(6):e12592.

5.
Witkowski M, et al.
Eur J Haematol.
2019 Dec;103(6):531-541.

6.
Yasir M, et al.
Corticosteroid Adverse Effects.
2021 Jul 8.
In: StatPearls [Internet].

The MCC number REV22071246 is valid from 2023-07-17, and the information expires and is deemed invalid
.

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