Treatment patterns and outcomes of second-line rituximab and thrombopoietin receptor agonists in adult immune thrombocytopenia: A Canadian retrospective cohort study
| العنوان: | Treatment patterns and outcomes of second-line rituximab and thrombopoietin receptor agonists in adult immune thrombocytopenia: A Canadian retrospective cohort study |
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| المؤلفون: | John Podstawka, Erika Wall, Lauren Bolster, Jeffery M. Patterson, M. Dawn Goodyear, Natalia Rydz, Haowei L. Sun |
| المصدر: | Thrombosis Research. 220:5-11 |
| بيانات النشر: | Elsevier BV, 2022. |
| سنة النشر: | 2022 |
| مصطلحات موضوعية: | Adult, Purpura, Thrombocytopenic, Idiopathic, Canada, Recombinant Fusion Proteins, Hemorrhage, Receptors, Fc, Hematology, Thrombocytopenia, Hydrazines, Thrombopoietin, Chronic Disease, Humans, Rituximab, Receptors, Thrombopoietin, Intracranial Hemorrhages, Retrospective Studies |
| الوصف: | The optimal choice of second-line treatment for immune thrombocytopenia (ITP) is unclear. Guidelines recommend either rituximab, splenectomy, or thrombopoietin receptor agonists (TPO-RA). There is, however, scarce data comparing treatment patterns, outcomes and resource utilization across second-line treatments. Despite Canada's universal healthcare system, publicly funded access to second-line ITP therapies is highly variable across provinces/territories.To describe treatment patterns and compare health service utilization and outcomes among recipients of second-line rituximab and TPO-RA for ITP.In this multicentre retrospective cohort study, we included adults who received second-line ITP therapies rituximab, eltrombopag and romiplostim (2012-2020) in Alberta, Canada. Patients were identified through a provincially-funded special drug access (STEDT) program. We examined treatment patterns, predictors of second-line treatment, hospitalizations, blood product utilization, and outcomes. Kaplan-Meier survival curves were used to estimate the cumulative incidence of ITP-related hospitalizations (bleeding or infections), overall survival (OS) and relapse-free survival (RFS). Cox proportional hazards regression was used to examine the impact of second-line therapy on OS.223 patients received rituximab (67 %), eltrombopag (29 %), and romiplostim (4 %). TPO-RA recipients experienced significantly longer time from ITP diagnosis to second-line therapy compared with rituximab recipients (15.9 vs 6.7 months, P 0.0001), accompanied by significantly higher platelet and IVIG utilization prior to second-line therapy. Age (adjusted odds ratio [aOR] 1.04, 95 % CI 1.02-1.07, P 0.0001) and prior intracranial hemorrhage (aOR 12.7, 95 % CI 1.6-272.8, P = 0.03) were significant predictors of second-line TPO-RA. TPO-RA is associated with a trend towards longer median RFS (6.3 vs 3.8 years, P = 0.06) compared with rituximab, and similar rates of ITP-related hospitalizations, major bleeding, and thromboembolism. Age, time period, and Charlson comorbidity index, but not second-line ITP therapy, were significant predictors of OS.Our study identified older age and intracranial hemorrhage as predictors of second-line TPO-RA prescription in a real-world practice. There were no significant differences in hospitalizations and outcomes between second-line rituximab and TPO-RA, although delayed initiation of TPO-RA was associated with higher blood product utilization. |
| تدمد: | 0049-3848 2012-2020 |
| DOI: | 10.1016/j.thromres.2022.09.021 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::ac08741d2201473cc0fe69ee04317571 https://doi.org/10.1016/j.thromres.2022.09.021 |
| Rights: | CLOSED |
| رقم الانضمام: | edsair.doi.dedup.....ac08741d2201473cc0fe69ee04317571 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 00493848 20122020 |
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| DOI: | 10.1016/j.thromres.2022.09.021 |