Transient Complete Recovery of Chronic Refractory Idiopathic Thrombocytopenic Purpura After Treatment with Monoclonal Antibody Targeting SARS-CoV-2 Spike Protein

Overview

Journal Case Rep Hematol

Publisher Wiley

Specialty Hematology

Date 2022 Jun 10

PMID 35685064

Authors

Pooja Gogia

Yiqing Xu

Affiliations

Soon will be listed here.

Abstract

Idiopathic thrombocytopenic purpura (ITP), also known as immune thrombocytopenic purpura, is an immune-mediated acquired disease characterized by transient or persistent decrease of the platelet count due to autoimmune-related destruction of platelets. Therapy for ITP relies on competing and inhibiting the autoantibody binding and destruction (intravenous immunoglobulin and anti-D immunoglobulin and spleen tyrosine kinase (Syk) inhibitor fostamatinib), augmenting platelet production (thrombopoietin receptor agonists), immunosuppression to reduce the autoantibody production, as well as splenectomy. Studies on autoantigens on the platelets suggested epitopes to be located predominantly on the GP IIb/IIIa receptor or integrin IIb3, though the trigger for the development of ITP is unclear. We report a case here of a 37-year-old gentleman who has chronic ITP managed on eltrombopag, who after receiving monoclonal antibody against SARS-CoV-2 (mAb) i.e. casirivimab and imdevimab for his COVID-19 infection, demonstrated complete recovery of his platelet count for a short period of time. We discuss a few potential mechanisms of action and propose further studies to elucidate the therapeutic effect of COVID-19 mAb in ITP.

References

Fitzpatrick E, Wang J, Strome S . Engineering of Fc Multimers as a Protein Therapy for Autoimmune Disease. Front Immunol. 2020; 11:496. PMC: 7109252. DOI: 10.3389/fimmu.2020.00496. View

Xu P, Zhou Q, Xu J . Mechanism of thrombocytopenia in COVID-19 patients. Ann Hematol. 2020; 99(6):1205-1208. PMC: 7156897. DOI: 10.1007/s00277-020-04019-0. View

Neunert C, Terrell D, Arnold D, Buchanan G, Cines D, Cooper N . American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019; 3(23):3829-3866. PMC: 6963252. DOI: 10.1182/bloodadvances.2019000966. View

Moulis G, Germain J, Comont T, Brun N, Dingremont C, Castel B . Newly diagnosed immune thrombocytopenia adults: Clinical epidemiology, exposure to treatments, and evolution. Results of the CARMEN multicenter prospective cohort. Am J Hematol. 2017; 92(6):493-500. DOI: 10.1002/ajh.24702. View

Liu Y, Sun W, Guo Y, Chen L, Zhang L, Zhao S . Association between platelet parameters and mortality in coronavirus disease 2019: Retrospective cohort study. Platelets. 2020; 31(4):490-496. PMC: 7171387. DOI: 10.1080/09537104.2020.1754383. View

Cines D, Bussel J . SARS-CoV-2 Vaccine-Induced Immune Thrombotic Thrombocytopenia. N Engl J Med. 2021; 384(23):2254-2256. PMC: 8063912. DOI: 10.1056/NEJMe2106315. View

Ghadaki B, Nazi I, Kelton J, Arnold D . Sustained remissions of immune thrombocytopenia associated with the use of thrombopoietin receptor agonists. Transfusion. 2013; 53(11):2807-12. PMC: 3938454. DOI: 10.1111/trf.12139. View

Fujisawa K, OToole T, Tani P, Loftus J, Plow E, Ginsberg M . Autoantibodies to the presumptive cytoplasmic domain of platelet glycoprotein IIIa in patients with chronic immune thrombocytopenic purpura. Blood. 1991; 77(10):2207-13. View

Gonzalez-Lopez T, Pascual C, Alvarez-Roman M, Fernandez-Fuertes F, Sanchez-Gonzalez B, Caparros I . Successful discontinuation of eltrombopag after complete remission in patients with primary immune thrombocytopenia. Am J Hematol. 2014; 90(3):E40-3. DOI: 10.1002/ajh.23900. View

10.

Kojouri K, Vesely S, Terrell D, George J . Splenectomy for adult patients with idiopathic thrombocytopenic purpura: a systematic review to assess long-term platelet count responses, prediction of response, and surgical complications. Blood. 2004; 104(9):2623-34. DOI: 10.1182/blood-2004-03-1168. View

11.

Ghanima W, Khelif A, Waage A, Michel M, Tjonnfjord G, Ben Romdhan N . Rituximab as second-line treatment for adult immune thrombocytopenia (the RITP trial): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet. 2015; 385(9978):1653-61. DOI: 10.1016/S0140-6736(14)61495-1. View

12.

. An EUA for casirivimab and imdevimab for COVID-19. Med Lett Drugs Ther. 2021; 62(1614):201-202. View

13.

Chugh S, Darvish-Kazem S, Lim W, Crowther M, Ghanima W, Wang G . Rituximab plus standard of care for treatment of primary immune thrombocytopenia: a systematic review and meta-analysis. Lancet Haematol. 2015; 2(2):e75-81. DOI: 10.1016/S2352-3026(15)00003-4. View

14.

Swinkels M, Rijkers M, Voorberg J, Vidarsson G, Leebeek F, Jansen A . Emerging Concepts in Immune Thrombocytopenia. Front Immunol. 2018; 9:880. PMC: 5937051. DOI: 10.3389/fimmu.2018.00880. View

15.

Hu Z, Chen W, Liang W, Xu C, Sun W, Yi Y . Severe exacerbation of immune thrombocytopenia and COVID-19: the favorable response to corticosteroid-based therapy-a case report. Ann Hematol. 2020; 100(8):2135-2137. PMC: 7270513. DOI: 10.1007/s00277-020-04070-x. View

16.

Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold D . Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2008; 113(11):2386-93. DOI: 10.1182/blood-2008-07-162503. View

17.

He R, Reid D, Jones C, Shulman N . Spectrum of Ig classes, specificities, and titers of serum antiglycoproteins in chronic idiopathic thrombocytopenic purpura. Blood. 1994; 83(4):1024-32. View

18.

Lazarus A, Crow A . Mechanism of action of IVIG and anti-D in ITP. Transfus Apher Sci. 2003; 28(3):249-55. DOI: 10.1016/S1473-0502(03)00043-0. View

19.

Godeau B, Caulier M, Decuypere L, Rose C, Schaeffer A, Bierling P . Intravenous immunoglobulin for adults with autoimmune thrombocytopenic purpura: results of a randomized trial comparing 0.5 and 1 g/kg b.w. Br J Haematol. 1999; 107(4):716-9. DOI: 10.1046/j.1365-2141.1999.01766.x. View

20.

Schultz N, Sorvoll I, Michelsen A, Munthe L, Lund-Johansen F, Ahlen M . Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination. N Engl J Med. 2021; 384(22):2124-2130. PMC: 8112568. DOI: 10.1056/NEJMoa2104882. View