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Effect of a thrombopoietin receptor agonist on use of intravenous immune globulin in patients with immune thrombocytopenia.
Transfusion. 2016 Jan; 56(1):73-9.T

Abstract

BACKGROUND

Thrombopoietin receptor agonists are new treatments for patients with chronic immune thrombocytopenia (ITP). How one of these agent, romiplostim, has impacted practice patterns, especially the use of intravenous immune globulin (IVIG), has not been evaluated outside of clinical trials.

STUDY DESIGN AND METHODS

This was a retrospective cohort study of adult ITP patients treated with romiplostim in four Canadian centers. Patients had primary or secondary ITP and were followed for 1 year before starting weekly romiplostim treatment. We compared IVIG use, clinical outcomes, and cost before and after romiplostim.

RESULTS

Twenty-nine patients with ITP received romiplostim. Median age was 54 years (interquartile range [IQR], 45-63 years) and patients had a median of two prior ITP treatments (IQR, 1-4) including splenectomy (n = 7). Median platelet (PLT) count was 23 × 10(9) before and 124 × 10(9) after romiplostim. Median duration of romiplostim treatment was 3.7 months. Patients used a median of two IVIG infusions per year before and 0.7 per year after starting romiplostim (p = 0.16). For patients who received weekly romiplostim for at least 1 month (n = 19), IVIG infusions were three (IQR, 1-5) per year before and 0.7 (IQR, 0.4-1.6) per year after romiplostim. Results were squewed by two high IVIG users. Nineteen (66%) patients discontinued romiplostim treatment during follow-up because of lack of response (n = 8), sustained response (n = 5), toxicities (n = 4), or response to splenectomy (n = 2). Overall health care costs were similar before and after romiplostim when concomitant treatments, nursing resources, and hospitalizations were considered.

CONCLUSIONS

Romiplostim was associated with improved PLT counts and fewer IVIG infusions for most ITP patients. In practice, romiplostim was generally not continued long term and was cost neutral for overall ITP management.

Authors+Show Affiliations

Department of Medicine Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario. Canadian Blood Services.Department of Medicine Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario. McMaster Transfusion Research Program, Hamilton, Ontario, Canada.Department of Medicine Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario.McMaster Transfusion Research Program, Hamilton, Ontario, Canada.McMaster Transfusion Research Program, Hamilton, Ontario, Canada.Health Research Methodology, Department of Clinical Epidemiology and Biostatistics, McMaster University. McMaster Transfusion Research Program, Hamilton, Ontario, Canada.McMaster Transfusion Research Program, Hamilton, Ontario, Canada.Department of Medicine Division of Hematology, London Health Sciences Centre, London, Ontario, Canada.Department of Hemato-Oncology, Montreal University, Montreal, Quebec, Canada.Department of Medicine Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario.Windsor Regional Cancer Program, Windsor Regional Hospital, Windsor, Ontario, Canada.Department of Hemato-Oncology, Montreal University, Montreal, Quebec, Canada.Department of Medicine Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario. Canadian Blood Services.

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26400824

Citation

Zeller, Michelle P., et al. "Effect of a Thrombopoietin Receptor Agonist On Use of Intravenous Immune Globulin in Patients With Immune Thrombocytopenia." Transfusion, vol. 56, no. 1, 2016, pp. 73-9.
Zeller MP, Heddle NM, Kelton JG, et al. Effect of a thrombopoietin receptor agonist on use of intravenous immune globulin in patients with immune thrombocytopenia. Transfusion. 2016;56(1):73-9.
Zeller, M. P., Heddle, N. M., Kelton, J. G., Hamilton, K., Wang, G., Sholapur, N., Carruthers, J., Hsia, C., Blais, N., Toltl, L., Hamm, C., Pearson, M. A., & Arnold, D. M. (2016). Effect of a thrombopoietin receptor agonist on use of intravenous immune globulin in patients with immune thrombocytopenia. Transfusion, 56(1), 73-9. https://doi.org/10.1111/trf.13336
Zeller MP, et al. Effect of a Thrombopoietin Receptor Agonist On Use of Intravenous Immune Globulin in Patients With Immune Thrombocytopenia. Transfusion. 2016;56(1):73-9. PubMed PMID: 26400824.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of a thrombopoietin receptor agonist on use of intravenous immune globulin in patients with immune thrombocytopenia. AU - Zeller,Michelle P, AU - Heddle,Nancy M, AU - Kelton,John G, AU - Hamilton,Korinne, AU - Wang,Grace, AU - Sholapur,Naushin, AU - Carruthers,Julie, AU - Hsia,Cyrus, AU - Blais,Normand, AU - Toltl,Lisa, AU - Hamm,Caroline, AU - Pearson,Marc-André, AU - Arnold,Donald M, Y1 - 2015/09/24/ PY - 2015/04/27/received PY - 2015/06/26/revised PY - 2015/07/22/accepted PY - 2015/9/25/entrez PY - 2015/9/25/pubmed PY - 2016/5/26/medline SP - 73 EP - 9 JF - Transfusion JO - Transfusion VL - 56 IS - 1 N2 - BACKGROUND: Thrombopoietin receptor agonists are new treatments for patients with chronic immune thrombocytopenia (ITP). How one of these agent, romiplostim, has impacted practice patterns, especially the use of intravenous immune globulin (IVIG), has not been evaluated outside of clinical trials. STUDY DESIGN AND METHODS: This was a retrospective cohort study of adult ITP patients treated with romiplostim in four Canadian centers. Patients had primary or secondary ITP and were followed for 1 year before starting weekly romiplostim treatment. We compared IVIG use, clinical outcomes, and cost before and after romiplostim. RESULTS: Twenty-nine patients with ITP received romiplostim. Median age was 54 years (interquartile range [IQR], 45-63 years) and patients had a median of two prior ITP treatments (IQR, 1-4) including splenectomy (n = 7). Median platelet (PLT) count was 23 × 10(9) before and 124 × 10(9) after romiplostim. Median duration of romiplostim treatment was 3.7 months. Patients used a median of two IVIG infusions per year before and 0.7 per year after starting romiplostim (p = 0.16). For patients who received weekly romiplostim for at least 1 month (n = 19), IVIG infusions were three (IQR, 1-5) per year before and 0.7 (IQR, 0.4-1.6) per year after romiplostim. Results were squewed by two high IVIG users. Nineteen (66%) patients discontinued romiplostim treatment during follow-up because of lack of response (n = 8), sustained response (n = 5), toxicities (n = 4), or response to splenectomy (n = 2). Overall health care costs were similar before and after romiplostim when concomitant treatments, nursing resources, and hospitalizations were considered. CONCLUSIONS: Romiplostim was associated with improved PLT counts and fewer IVIG infusions for most ITP patients. In practice, romiplostim was generally not continued long term and was cost neutral for overall ITP management. SN - 1537-2995 UR - https://www.unboundmedicine.com/medline/citation/26400824/Effect_of_a_thrombopoietin_receptor_agonist_on_use_of_intravenous_immune_globulin_in_patients_with_immune_thrombocytopenia_ L2 - https://doi.org/10.1111/trf.13336 DB - PRIME DP - Unbound Medicine ER -