【ITP changes because of you】Phase 3

The content of this article is only for medical and health professionals.
ITP disease background and treatment progress Primary immune thrombocytopenia (ITP) is a bleeding disorder caused by autoimmune dysfunction in which the number of platelets is reduced
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Worldwide, the incidence of ITP is 2-10/100,000, and the peak incidence is in people aged 20-30 and over 60 years old 1,2
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The clinical goal of ITP therapy is to resolve bleeding events or prevent severe bleeding by providing adequate hemostasis
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At present, the first-line treatment drugs are mainly glucocorticoids, but some patients are hormone-dependent
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Hormone dependence refers to the need for more than 5 mg/d of prednisone or frequent intermittent application of glucocorticoids to maintain platelet count ≥30 × 109/L or to avoid bleeding
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Studies have shown that hormone therapy should be stopped as soon as possible after the onset of effects, but after reducing or stopping hormones, 70% to 90% of patients will relapse 4
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The "Chinese Guidelines for the Diagnosis and Treatment of Primary Immune Thrombocytopenia in Adults (2020 Edition)" pointed out that the dose of prednisone should be reduced as soon as possible after the onset of effect, and discontinued within 6 to 8 weeks.
second-line treatment
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For maintenance therapy, the safe dose of prednisone should not exceed 5mg/d
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Long-term use of glucocorticoids can cause adverse reactions such as hypertension, hyperglycemia, and acute gastric mucosal lesions, and some patients may develop osteoporosis and femoral head necrosis 1
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Let us listen to the experts' opinions on the treatment goals of ITP patients and the follow-up clinical treatment options for poor first-line hormone control
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Expert concept and clinical practice sharing Experts in this issue: Professor Zhang Shuaishuai, Professor Xu Ruirong, Professor Shen Yang, Professor Zhang Jilei Project, Peking Union Medical College Innovation Fund 1 paper published in top journals such as leukemia, Tianjin 131 Innovative Talents Training Project Reserve Talents Expert Concept Regarding the treatment goals of ITP patients, Professor Zhang Shuaishuai believes: "The treatment goal of ITP patients is to increase the number of platelets, increase the Avoid bleeding, improve the quality of life of patients, reduce the dosage of hormones, and gradually reduce the medication until the final withdrawal
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"Clinical practice sharing case 1 Basic information: Gender: Female Age: 22 years old Initial platelet level: 4 × 109/L Hormone inadequacy: Hormone dependence Table 1 Case 1 Follow-up and efficacy evaluation records Note: Hormones and eltrombopag are administered once a day (qd)
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Figure 1 The follow-up and efficacy evaluation of case 1 recorded that the initial platelet count of the patient was 4×109/L, and after 10 weeks of eltrombopag (50mg, qd) treatment, the platelet count increased to 193×109/L, reaching complete Response, that is, platelet count ≥ 100 × 109/L, and no bleeding manifestations
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Professor Xu Ruirong, Chief Physician and Master Supervisor of Nantong University Affiliated Hospital Former Deputy Director of the Department of Internal Medicine, Deputy Director of the Department of Hematology, Former Director of the Oncology Center Senior Visiting Scholar of Tokushima University School of Medicine Member of the study group, deputy director of the Hematology Branch and Internal Medicine Professional Committee of Nantong Medical Association, and member of the Jiangsu Provincial Occupational Disease Diagnosis Expert Bank.
Published more than 30 papers in the Chinese Journal of Hematology and Chinese Journal of Experimental Hematology.
2003 Nantong Science and Technology Progress Award (The first prize in 2002, the third prize in 2005), the first prize of the Science and Technology Progress Award of Jiangsu Provincial Health Department, the third prize of the Municipal Science and Technology Progress Award (2005), the pacesetter of medical ethics and integrity in Nantong City (2012) Specialties: hematological malignancies ( Expert concept of diagnosis and treatment of acute, chronic leukemia, lymphoma, myeloma) and thrombocytopenia According to the treatment goal of ITP patients, Professor Xu Ruirong believes: "The treatment goal of ITP patients is to prevent the patient from bleeding and increase the patient's platelet count to a safe level ( ≥30×109/L), so as to meet the patient’s work and life wishes
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” Basic information of clinical practice sharing case 2: Gender: Female Age: 46 years old Initial platelet level: 14×109/L Hormone insufficiency: hormone dependence table 2 Case 2 Follow-up and efficacy evaluation records Note: Both hormones and eltrombopag are administered once a day (qd)
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Figure 2 The follow-up and efficacy evaluation of case 2 recorded that the initial platelet count of the patient was 14×109/L, and after 10 weeks of eltrombopag treatment, the platelet count increased to 112×109/L, achieving a complete response, that is, the platelet count ≥100×109/L, and no bleeding
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Professor Shen Yang, Chief Physician and Doctoral Supervisor of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Director of the First Blood Cleansing Ward of the National Translational Medicine Center He is currently an international member of the American Society of Hematology, a member of the Standing Committee of the Chronic Disease Prevention and Management Professional Committee of the China Society for Health Information and Healthcare Big Data, a member of the Professional Committee of Oncology Hematology of the China Anti-Cancer Association, a degree evaluation expert of the Ministry of Education, and a member of the Shanghai Municipal Committee of the Chinese Anti-Cancer Association.
The main research direction of the member of the Anti-Cancer Association is the molecular stratification, markers and big data research of acute leukemia.
BCJ" and other domestic and foreign journals have published dozens of papers.
As the main author, he has won the second prize of the National Natural Science Award, the Shanghai Natural Science Special Award, the third prize of the Shanghai Clinical Medical Achievement Award, and the Shanghai Science and Technology Achievement Award.
Undertook a number of projects such as general projects of the National Natural Science Foundation of China, key projects of strategic international innovation cooperation of the Ministry of Science and Technology, and sub-projects of industry funds of the Ministry of Health
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Instructing more than 10 experts with doctors and masters on the treatment goals of ITP patients, Professor Shen Yang believes: "The treatment goals of ITP patients are to rapidly increase platelets, reduce bleeding, reduce bleeding risk, minimize drug side effects, and improve patients' life.
Quality
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"Clinical Practice Sharing Case 3 Basic Information: Gender: Female Age: 67 Years Old Initial Platelet Level: 8 × 109/L Hormone Poor Status: Hormone Dependence Pa drug is once a day (qd)
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Figure 3 The follow-up and efficacy evaluation of case 3 recorded that the initial platelet count of the patient was 8 × 109/L.
After 12 weeks of eltrombopag (50mg, qd) treatment, the platelet count increased to 51 × 109/L, reaching the therapeutic level.
Effective, that is, the platelet count after treatment is ≥30×109/L, which is at least 2 times higher than the basic platelet count, and there is no bleeding
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Prof.
Zhang Jilei, Chief Physician of the Department of Hematology, Tai'an Central Hospital, Master's Degree, Deputy Chief Physician, Expert Concept Regarding the treatment goals of ITP patients, Prof.
Zhang Jilei believes: "The treatment goal of ITP patients is to reduce the risk of bleeding and improve the quality of life of patients
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" Clinical practice sharing Basic information of case 4: Gender: Female Age: 55 years old Initial platelet level: 12×109/L Poor hormone status: hormone dependence Table 4 Case 4 Follow-up and efficacy evaluation records once (qd)
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Figure 4 The follow-up and efficacy evaluation of case 4 recorded that the initial platelet count of the patient was 12×109/L.
After 9 weeks of eltrombopag (50mg, qd) treatment, the platelet count increased to 92×109/L, reaching the therapeutic level.
Effective, that is, the platelet count after treatment is ≥30×109/L, which is at least 2 times higher than the basic platelet count, and there is no bleeding
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Reference 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.
Witkowski M, et al.
Eur J Haematol.
2019 Dec;103(6):531-541.
MCC No.
REV22041922 is valid on 2023-04-18, and the data is expired and deemed invalid
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