Treatment Trends and Risks of Corticosteroid Use in Adult Primary Immune Thrombocytopenia: a Claims Database Study in Japan

Overview

Journal Int J Hematol

Specialty Hematology

Date 2024 Dec 12

PMID 39668284

Authors

Hirokazu Kashiwagi

Isao Miura

Naohiko Terasawa

Ken-Ichi Iwayama

Yuka Furukawa

Makoto Kanenishi

Affiliations

Soon will be listed here.

Abstract

Recent trends in the treatment of primary immune thrombocytopenia (ITP) were investigated using a claims database that included data from 16,161 Japanese patients with ITP collected from April 2014 to August 2022. Of the 4144 adult patients analyzed, 1276 received corticosteroids. The mean and median durations of corticosteroid use were 115.31 and 41 days, respectively. The time to withdrawal of corticosteroids was significantly shorter in 2020 to 2021 than in 2015 to 2019. Additionally, the number of prescriptions for thrombopoietin receptor agonists increased from 2015 to 2021 and exceeded that of corticosteroids in 2021. While these results suggest a trend towards reduction in corticosteroid use in real-world settings in Japan, 12.00% of patients received a corticosteroid dose of ≥ 10 mg/day at Week 12. Furthermore, 23.05% of patients continued to receive corticosteroids at Week 24, indicating that some patients were still receiving long-term corticosteroid treatment. The risk of adverse outcomes was significantly associated with corticosteroid use. In conclusion, new treatment options may lead to more sophisticated ITP management with less corticosteroid use, although further research and reconsideration of clinical practice guidelines is needed.

References

Arnold D . Bleeding complications in immune thrombocytopenia. Hematology Am Soc Hematol Educ Program. 2015; 2015:237-42. DOI: 10.1182/asheducation-2015.1.237. View

Mathias S, Gao S, Miller K, Cella D, Snyder C, Turner R . Impact of chronic Immune Thrombocytopenic Purpura (ITP) on health-related quality of life: a conceptual model starting with the patient perspective. Health Qual Life Outcomes. 2008; 6:13. PMC: 2275726. DOI: 10.1186/1477-7525-6-13. View

Van de Vondel S, Vandenbriele C, Gheysens G, Verhamme P, Janssens A . Catastrophic antiphospholipid syndrome in an immune thrombocytopenia patient treated with avatrombopag. Res Pract Thromb Haemost. 2023; 7(3):100125. PMC: 10099321. DOI: 10.1016/j.rpth.2023.100125. View

LaMoreaux B, Barbar-Smiley F, Ardoin S, Madhoun H . Two cases of thrombosis in patients with antiphospholipid antibodies during treatment of immune thrombocytopenia with romiplostim, a thrombopoietin receptor agonist. Semin Arthritis Rheum. 2015; 45(4):e10-2. DOI: 10.1016/j.semarthrit.2015.07.008. View

Okada A, Yasunaga H . Prevalence of Noncommunicable Diseases in Japan Using a Newly Developed Administrative Claims Database Covering Young, Middle-aged, and Elderly People. JMA J. 2022; 5(2):190-198. PMC: 9090547. DOI: 10.31662/jmaj.2021-0189. 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

Oray M, Abu Samra K, Ebrahimiadib N, Meese H, Foster C . Long-term side effects of glucocorticoids. Expert Opin Drug Saf. 2016; 15(4):457-65. DOI: 10.1517/14740338.2016.1140743. View

Pierrot-Deseilligny Despujol C, Michel M, Khellaf M, Gouault M, Intrator L, Bierling P . Antiphospholipid antibodies in adults with immune thrombocytopenic purpura. Br J Haematol. 2008; 142(4):638-43. DOI: 10.1111/j.1365-2141.2008.07228.x. View

Wong T, Majewska R, Tomiyama Y . Management of primary immune thrombocytopenia in a real-world setting in Japan: eltrombopag versus corticosteroids. Int J Hematol. 2021; 114(2):152-163. DOI: 10.1007/s12185-021-03149-z. View

10.

Bidot C, Jy W, Horstman L, Ahn E, Yaniz M, Ahn Y . Antiphospholipid antibodies (APLA) in immune thrombocytopenic purpura (ITP) and antiphospholipid syndrome (APS). Am J Hematol. 2006; 81(6):391-6. DOI: 10.1002/ajh.20571. View

11.

Portielje J, Westendorp R, Kluin-Nelemans H, Brand A . Morbidity and mortality in adults with idiopathic thrombocytopenic purpura. Blood. 2001; 97(9):2549-54. DOI: 10.1182/blood.v97.9.2549. View

12.

Berti D, Moons P, Dobbels F, Deuson R, Janssens A, de Geest S . Impact of corticosteroid-related symptoms in patients with immune thrombocytopenic purpura: results of a survey of 985 patients. Clin Ther. 2008; 30(8):1540-52. DOI: 10.1016/j.clinthera.2008.08.005. View

13.

Kashiwagi H, Kuwana M, Hato T, Takafuta T, Fujimura K, Kurata Y . Reference guide for management of adult immune thrombocytopenia in Japan: 2019 Revision. Int J Hematol. 2020; 111(3):329-351. PMC: 7223085. DOI: 10.1007/s12185-019-02790-z. View

14.

Kurata Y, Fujimura K, Kuwana M, Tomiyama Y, Murata M . Epidemiology of primary immune thrombocytopenia in children and adults in Japan: a population-based study and literature review. Int J Hematol. 2011; 93(3):329-335. DOI: 10.1007/s12185-011-0791-1. View

15.

Provan D, Arnold D, Bussel J, Chong B, Cooper N, Gernsheimer T . Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv. 2019; 3(22):3780-3817. PMC: 6880896. DOI: 10.1182/bloodadvances.2019000812. View

16.

Terrell D, Neunert C, Cooper N, Heitink-Polle K, Kruse C, Imbach P . Immune Thrombocytopenia (ITP): Current Limitations in Patient Management. Medicina (Kaunas). 2020; 56(12). PMC: 7761470. DOI: 10.3390/medicina56120667. View

17.

Mingot-Castellano M, Canaro Hirnyk M, Sanchez-Gonzalez B, Alvarez-Roman M, Barez-Garcia A, Bernardo-Gutierrez A . Recommendations for the Clinical Approach to Immune Thrombocytopenia: Spanish ITP Working Group (GEPTI). J Clin Med. 2023; 12(20). PMC: 10607106. DOI: 10.3390/jcm12206422. View

18.

Vestergaard P, Olsen M, Paaske Johnsen S, Rejnmark L, Sorensen H, Mosekilde L . Corticosteroid use and risk of hip fracture: a population-based case-control study in Denmark. J Intern Med. 2003; 254(5):486-93. DOI: 10.1046/j.1365-2796.2003.01219.x. View

19.

Amiche M, Abtahi S, Driessen J, Vestergaard P, de Vries F, Cadarette S . Impact of cumulative exposure to high-dose oral glucocorticoids on fracture risk in Denmark: a population-based case-control study. Arch Osteoporos. 2018; 13(1):30. PMC: 5857556. DOI: 10.1007/s11657-018-0424-x. View

20.

Price D, Castro M, Bourdin A, Fucile S, Altman P . Short-course systemic corticosteroids in asthma: striking the balance between efficacy and safety. Eur Respir Rev. 2020; 29(155). PMC: 9488828. DOI: 10.1183/16000617.0151-2019. View