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Second-line treatments and outcomes for immune thrombocytopenia: A retrospective study with electronic health records.

ABSTRACT: Background:Second-line treatment for immune thrombocytopenia (ITP) is not well reported for patients treated in real-world clinical settings. Objective:The purpose of this study was to compare outcomes of four second-line treatments for ITP. Patients/methods:Included adult patients had at least two medical records containing ITP diagnoses and second-line eltrombopag, romiplostim, rituximab, or splenectomy. Date of treatment initiation or splenectomy was set as index date, between July 1, 2008, and March 31, 2017. Patients had first-line corticosteroid or intravenous immune globulin treatment and continuous database activity from 6 months before to 12 months after index. Patient characteristics, treatment patterns, platelet counts, bleeding-related episodes (BREs), and thrombotic events (TEs) were compared by second-line treatment cohort. Results:The sample included 3332 patients (mean age, 60.5 years; 52.3% female): eltrombopag (5.8%), romiplostim (9.9%), rituximab (73.3%), and splenectomy (11.0%). Patients having splenectomy were younger, more likely female and commercially insured, and less likely to require a third line of treatment than medical regimen cohorts. Proportions of patients having treatment-free (?180 days with no second-line index or rescue agent) periods varied significantly (P = .01) by regimen: 33% for eltrombopag, 23% for romiplostim, 26% for rituximab, and 17% for splenectomy. All regimens significantly improved platelet counts, while TE and BRE rates differed significantly (P = .03 and P = .01, respectively) when all treatment groups were compared. Conclusions:Over an average 7-year follow-up, all second-line regimens improved platelet counts, but eltrombopag yielded the highest proportion of patients with completely treatment-free periods of at least 180 days.

SUBMITTER: Lal LS

PROVIDER: S-EPMC7590333 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Second-line treatments and outcomes for immune thrombocytopenia: A retrospective study with electronic health records.

Lal Lincy S LS Said Qayyim Q Andrade Katherine K Cuker Adam A

Research and practice in thrombosis and haemostasis 20200911 7

<h4>Background</h4>Second-line treatment for immune thrombocytopenia (ITP) is not well reported for patients treated in real-world clinical settings.<h4>Objective</h4>The purpose of this study was to compare outcomes of four second-line treatments for ITP.<h4>Patients/methods</h4>Included adult patients had at least two medical records containing ITP diagnoses and second-line eltrombopag, romiplostim, rituximab, or splenectomy. Date of treatment initiation or splenectomy was set as index date, b ...[more]

PMID: 33134779

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Project description:BackgroundHepatorenal syndrome (HRS) is among the leading causes of hospitalization and mortality in patients with chronic liver disease.ObjectiveTo assess the HRS patient journey from preadmission to postdischarge to understand patient characteristics, disease progression, treatment patterns, and outcomes.MethodsWe conducted a retrospective study using real-world data from a nationwide electronic health record database (Cerner Health Facts, Kansas City, Missouri). We used ICD-9/10 diagnosis codes to identify patients hospitalized with HRS between January 1, 2009, and January 31, 2018. We assessed patient characteristics and history, clinical presentation, treatment, and outcomes. Regression analysis was conducted to assess the association between patient characteristics and survival while adjusting for demographic and clinical covariates.ResultsThe study included 3563 patients (62% men). Precipitants of HRS included gastrointestinal bleeding (18%), diuretics and infections (30%), and paracentesis (26%). Although 21% of patients had liver injury exclusively associated with alcohol use, 20% had hepatitis C, 8% had nonalcoholic steatohepatitis, and the etiology of the remainder (51%) was either some combination of conditions or unknown. A total of 42% of patients received vasopressors, including octreotide and midodrine (10%), other combinations of vasopressors (11%), or another single vasopressor (21%). In-hospital mortality was 34%, and 14% of patients were discharged to hospice. Regression analysis showed patients with acute-on-chronic liver failure had higher mortality in acute-on-chronic liver failure grades 1 (odds ratio = 1.59), 2 (odds ratio = 2.49), and 3 (odds ratio = 4.53) versus no acute-on-chronic liver failure. Among survivor patients, 38% were readmitted within 90 days of discharge; 23% of readmissions were HRS-related.ConclusionsThe HRS patient journey presented in this study highlights inconsistencies in, and provides insight into, associated hospital-based treatment strategies. A mortality rate of 34% along with a readmission rate of 23% associated with HRS-related complications warrant more disease awareness and effective treatment. Further research is needed to examine the interactions between the etiology of cirrhosis, precipitants, treatment, and outcomes. (Curr Ther Res Clin Exp. 2022; 82:XXX-XXX).

Dataset Information

Second-line treatments and outcomes for immune thrombocytopenia: A retrospective study with electronic health records.

Publications

Second-line treatments and outcomes for immune thrombocytopenia: A retrospective study with electronic health records.

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