* Revolade (eltrombopag) showed lower rate of bleeding-related episodes and similar rate of thrombotic events vs. romiplostim, rituximab and splenectomy, in a retrospective analysis of US electronic health records
* Patients who received splenectomy, as second-line regimen, showed highest platelet counts and most frequent thrombotic event rates among groups receiving other therapies
* Immune thrombocytopenia (ITP) is a rare blood disorder where there is an increased risk of bleeding due to a low number of platelets
Novartis announced results of a retrospective, real- world evidence study in patients with immune thrombocytopenia (ITP) treated with Revolade(® )(eltrombopag), compared to other second-line therapies. The data demonstrated that patients experienced better clinical outcomes with Revolade, in terms of fewer bleeding episodes. The data were presented during the 60(th) Annual Meeting of the American Society of Hematology (ASH) in San Diego.
“Despite advances in treating immune thrombocytopenia, many patients remain at risk for bleeding episodes,” said Samit Hirawat, MD, Head, Novartis Oncology Global Drug Development. “With these kind of real-world data, we can reimagine care by more clearly understanding the outcomes of a range of treatments and, in turn, helping healthcare providers better navigate available options with their patients.”
Electronic health records (EHR) data from January 1, 2009 to September 30, 2016 from the Optum(®) EHR database were used to evaluate the effect of second-line agents for ITP. Identified patients had the following characteristics: 18 years or older, evidence of previous treatment with steroids or immune globulin products, and activity in the database for at least 6 months prior to and 12 months post initiation of a second-line agent. Treatment outcomes evaluated included platelet counts, bleeding related episodes (BREs), and thrombotic events (TEs) over the 12-month period following starting a second-line therapy.
Of the 2,526 adults that met the inclusion criteria, 110 (4.4%) received eltrombopag, 189 (7.5%) romiplostim, 1,488 (58.9%) rituximab, and 260 (10.3%) splenectomy, with the remaining 479 (18.9%) receiving a mix of other second-line agents. Compared to baseline, platelet counts increased in all treatment cohorts. The proportion of patients who experienced BREs ranged from 25.5% (eltrombopag) to 36.5% (romiplostim), while TEs were observed in all treatment cohorts ranging from 11.6% (eltrombopag) to 15.7% (splenectomy). An additional analysis demonstrated that patients with ITP who had a splenectomy as second- line treatment had the highest mean platelet counts during the first 12 months post treatment initiation, but were at greatest risk for TEs (15.7%) (e.g., stroke, transient ischemic attack, myocardial infarction, deep vein thrombosis, and pulmonary embolism) compared to 11.6% (eltrombopag), 12.7% (romiplostim), and 13.9% (rituximab).
“These real-world data can help doctors as they weigh options for second-line therapy with their patients.” Adam Cuker, MD, Assistant Professor of Medicine at the University of Pennsylvania. “They may also help explain the long-term trend toward deferring splenectomies until after other lines of treatment have been tried.”
Immune thrombocytopenia is a rare and potentially serious blood disorder where there is an increased risk of bleeding due to a low number of platelets. As a result, patients with ITP experience bruising, bleeding and, in rare cases, serious hemorrhage that can be fatal.[1] The goal of treatment in chronic/persistent ITP is to maintain a safe platelet count that reduces the risk of bleeding.[1]
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