Prise en charge du purpura thrombopénique immunologique en France avant la mise à disposition des agonistes du récepteur à la thrombopoïétine

Purpose

Adult immune thrombocytopenia (ITP) is an auto-immune disease with most often a chronic course for which a consensual therapeutic strategy is missing. The objective of this study was to describe treatment practices in adult ITP in France before the era of thrombopoietin receptor (TpoR) agonists.

Methods

A retrospective observational study was conducted in eight hospitals in France. All eligible patients were at least 18 years of age and were seen for a chronic ITP between January 2004 and March 2006 in one of the participating centers. Data were collected retrospectively from clinical charts. ITP treatment from disease onset was analyzed for every patient according to the time of diagnosis.

Results

The study included 122 patients (73% of women) with a mean age of 52.6 years. Patients in whom ITP had been diagnosed less than 4 years earlier (n = 71) received on average 2.9 treatment lines. Corticosteroids possibly combined with intravenous immunoglobulins were most often used as a first-line. From the second line, up to 12 different regimens were identified. As a third line, rituximab and splenectomy were the most common therapeutic procedures. The number of splenectomy tended to decrease over time.

Conclusion

This analysis reflects the great heterogeneity into the management of chronic ITP. Whether such heterogeneity has declined after national guidelines have been produced remains to be assessed as well as the place of the newly develop TpoR agonists.