OC 73.3 - Thrombopoietin receptor agonists (TPO-RAs) in older patients with primary immune thrombocytopenia (ITP): effective and safe? Real World Data from the UK adult ITP registry.

Wednesday, July 13, 2022

10:45 AM – 11:00 AM

Location: ExCel Center, ICC Capital Suite Room 14-16

Presentation Format: In-Person

Presenting Author(s)

Priyanka Raheja, MBBS, MD

Haematology consultant
Royal London Hospital
London, England, United Kingdom

Co-Author(s)

HM

Haroon Miah

Data Manager and Study Co-ordinator
Queen Mary University London
London, England, United Kingdom
AM

Atiqa Miah

Data Manager
Royal London Hospital
London, England, United Kingdom
LT

Lousie Taylor

Clinical nurse specialist
Royal London Hospital
London, England, United Kingdom
TB

Tina T. Biss, BM BS, MRCP, FRCPath, MD

Consultant Haematologist
The Newcastle upon Tyne Hospitals NHS Foundation Trust
Newcastle upon Tyne, England, United Kingdom
GE

Gillian Evans

Haematology consultant
East Kent Hospitals University NHS Foundation Trust
Kent, England, United Kingdom
MS

Marie Scully

Professor
Bloomsbury Institute of Intensive Care Medicine
London, England, United Kingdom
JH

Joannes Hermans

Consultant Haematologist
Nottingham University Hospitals NHS Trust
Nottingham, England, United Kingdom
SM

Scott Marshall

Haematology consultant
Sunderland Royal Hospital
Sunderland, England, United Kingdom
MK

Mari Kilner

Haematology consultant
Northumbria Healthcare NHS Foundation Trust
Northumbria, England, United Kingdom
RR

Rachel Rayment

Haematology consultant
Cardiff and Vale, University Hospital of Wales
Cardiff, England, United Kingdom
LR

Lisa Robinson

Haematology consultant
County Hospital, Wye Valley NHS Trust (Hereford)
Wye, England, United Kingdom
SJ

Sarah Johns

Haematology consultant
Royal Cornwall Hospital
Cornwall, England, United Kingdom
CR

Ciro Rinaldi

Haematology consultant
Pilgrim Hospital
Pilgrim, England, United Kingdom
HJ

Helen Jackson

Haematology consultant
Aneurin Bevan University Health Board, Royal Gwent
Gwent, England, United Kingdom
SA

Sam Ackroyd

Haematology consultant
Bradford Royal Infirmary
Bradford, England, United Kingdom
AN

Adrian Newland

Haematology consultant
Royal London Hospital
London, England, United Kingdom
DP

Drew Provan

Consultant Haematologist
Royal London Hospital
London, England, United Kingdom
NC

Nichola Cooper

Department of Medicine
Hammersmith Hospital
London, England, United Kingdom
VM

Vickie McDonald, MA MRCP FRCPath PhD

Consultant Haematologist
Barts Health NHS Trust, The Royal London Hospital
London, England, United Kingdom

Background: Adult primary immune thrombocytopenia (ITP) is a rare acquired immune-mediated disorder. It may have a more aggressive course in older patients with the potential for more complex management due to co-morbidities and possible drug interactions. Thrombopoietin receptor agonists (TPO-RAs) have reported overall response rates of 50-90% in ITP.

Aims: To assess outcomes after TPO-RA in patients >60y.

Methods: Data analysed from the UK adult primary ITP registry (https://www.qmul.ac.uk/itpregistry/) for response and events of special interest.

Results: There were 4590 participants as of 4th January 2021. Of these 485 patients (259M; 226F, median age 73y (IQR 67.9-79.2) >60y had received TPO-RA therapy (253 eltrombopag and 232 romiplostim) (Table 1). The mean time from diagnosis to first TPO-RA treatment was 1.8 years, with median 3 lines of treatment prior to TPO-RA. The median platelet count up to 2 weeks prior to starting TPO-RA was 88.7x109/L, from 2-4 weeks after TPO-RA was 99x109/L and at 3-4 months was 97x109/L. The overall response (OR) rates at 3-4 months were 72.5%; at 6-7 months were 72% and at 1-2 years were 70%.
Bleeding events were reduced amongst all groups following TPO-RA treatment. In the year prior to starting TPO-RA there were 316 muco-cutaneous bleed events and 82 organ bleeds, in the year after there were 193 and 40, respectively.
Cardiovascular (CV) risk factors before ITP diagnoses are shown in table 2. Over 50% had at least one risk factor for CV disease. Before / after TPO-RA there were 60 and 17 arterial thrombotic events (ATE); 18 and 17 venous thrombotic events (VTE), respectively.

Conclusion(s): This data confirms efficacy of TPO-RA in this group with comparable response rates to the literature based on platelet count response. There does not appear to be an increase in reported thrombotic events after therapy in this group, despite a large number of co-morbidities.