Contributions
Abstract: EP1159
Type: E-Poster Presentation
Session title: Platelet disorders
Background
Immune thrombocytopenia (ITP) affects 2–4/100,000 adults globally. Recent ASH and ICR guidelines recommend short duration (<6 weeks) corticosteroids as first-line therapy for ITP, and thrombopoietin receptor agonists (TPO-RAs) and rituximab as second-line therapy before splenectomy. There are limited data on the epidemiology and management of ITP patients (pts) in Algeria.
Aims
Here we investigate the epidemiology and management of ITP pts treated in public hospitals in Algeria from September 2017─August 2018.
Methods
This was a non-interventional, longitudinal, nationwide estimation study of ITP pts ≥16 years (y) of age, either previously (before 1 September 2017) or newly (September 2017─August 2018) diagnosed with ITP. Assessments included pt characteristics, disease etiology, ITP incidence (by age, sex, diagnosis stage, and Algeria province), ITP prevalence, and ITP treatment regimens.
Results
Overall 1746 pts were listed of whom 587 did not provide consent; 1159 were included in the analysis. Among eligible pts, 895 (77.2%) were women, 173 (14.9%) were newly diagnosed, and 986 (85.1%) were previously diagnosed with ITP. A total of 966 pts (83.3%) had no comorbidities conferring bleeding risk. Etiological investigations for diagnosis showed that a majority of pts were evaluated for autoimmune disease (79.9%) and/or lymphoid hemopathy (75.9%) (Table). At diagnosis, median age was 36y (range 0–94y), and platelet counts (103/mm3) were 0–30 in 124 pts (71.7%), 30–50 in 20 pts (11.6%), 50–100 in 28 pts (16.2%), and >100 in 1 (0.6%) pt. Khellaf score was ≤8 for 45 (26.0%) pts, >8 for 8 (4.6%) pts, and missing for 120 (69.4%) pts. Bleeding risk was grade 0 (low), 1, 2, 3, and 4 for 50 (28.9%), 24 (13.9%), 34 (19.7%), 52 (30.1%), and 13 (7.5%) pts, respectively; 55 (31.8%) pts were asymptomatic, 58 (33.5%) ecchymotic, and 60 (34.7%) severely hemorrhagic.
The incidence (95% CI) of ITP was 0.85 (0.75, 0.96) per 100,000 inhabitants, increasing with age from 0.5 (0.43, 0.68) for pts 15–35y old to 2.4 (1.60, 3.51) for pts ≥75y old. Women had a higher incidence of ITP than men (1.2 [1.02, 1.37] vs 0.5 [0.43, 0.67]). Incidence of ITP varied with diagnosis stage (asymptomatic: 0.4 [0.31, 0.45]; ecchymosis: 0.1 [0.10, 0.19]; severe hemorrhage: 0.1 [0.06, 0.13]), and Algeria province (lowest in a public site in Tebessa: 0.1 [0.02, 0.92], highest in a public site in Sidi Bel Abbès: 1.6 [0.93, 2.89]). The prevalence (95% CI) of ITP was 5.7 (5.39, 5.93) per 100,000 inhabitants, increasing with age from 3.2 (2.78, 3.67) for pts 15–25y old to 11.9 (9.68, 13.08) for pts 65–75y old, and then decreasing to 7.6 (4.79, 12.06) for pts ≥85y old. Women had a higher prevalence of ITP than men (8.8 [8.33, 9.29]) vs 2.6 [2.34, 2.85]).
Corticosteroids were the primary treatment for new (136 [78.6%]) and previously (795 [80.7%]) diagnosed pts. Last/ongoing treatments at study inclusion were corticosteroids (712 [72.2%]), rituximab (56 [5.7%]), immunoglobulins (30 [3.0%]), TPO-RA (romiplostim: 19 [1.9%]), and antibacterials (4 [0.4%]). Among previously diagnosed pts, 172 (17.4%) had splenectomy with a median time of 19 months from ITP diagnosis.
Conclusion
The incidence and prevalence of ITP in Algeria increased with age, and both were higher in women than men, conforming to global trends. The results highlight the need to reduce corticosteroid treatment duration and improve second-line therapy options such as TPO-RAs before splenectomy (in line with the recently updated ASH and ICR guidelines) for management of adult ITP pts in Algeria.
Keyword(s): Epidemiology, Immune thrombocytopenia (ITP), Incidence, Prevalence
Abstract: EP1159
Type: E-Poster Presentation
Session title: Platelet disorders
Background
Immune thrombocytopenia (ITP) affects 2–4/100,000 adults globally. Recent ASH and ICR guidelines recommend short duration (<6 weeks) corticosteroids as first-line therapy for ITP, and thrombopoietin receptor agonists (TPO-RAs) and rituximab as second-line therapy before splenectomy. There are limited data on the epidemiology and management of ITP patients (pts) in Algeria.
Aims
Here we investigate the epidemiology and management of ITP pts treated in public hospitals in Algeria from September 2017─August 2018.
Methods
This was a non-interventional, longitudinal, nationwide estimation study of ITP pts ≥16 years (y) of age, either previously (before 1 September 2017) or newly (September 2017─August 2018) diagnosed with ITP. Assessments included pt characteristics, disease etiology, ITP incidence (by age, sex, diagnosis stage, and Algeria province), ITP prevalence, and ITP treatment regimens.
Results
Overall 1746 pts were listed of whom 587 did not provide consent; 1159 were included in the analysis. Among eligible pts, 895 (77.2%) were women, 173 (14.9%) were newly diagnosed, and 986 (85.1%) were previously diagnosed with ITP. A total of 966 pts (83.3%) had no comorbidities conferring bleeding risk. Etiological investigations for diagnosis showed that a majority of pts were evaluated for autoimmune disease (79.9%) and/or lymphoid hemopathy (75.9%) (Table). At diagnosis, median age was 36y (range 0–94y), and platelet counts (103/mm3) were 0–30 in 124 pts (71.7%), 30–50 in 20 pts (11.6%), 50–100 in 28 pts (16.2%), and >100 in 1 (0.6%) pt. Khellaf score was ≤8 for 45 (26.0%) pts, >8 for 8 (4.6%) pts, and missing for 120 (69.4%) pts. Bleeding risk was grade 0 (low), 1, 2, 3, and 4 for 50 (28.9%), 24 (13.9%), 34 (19.7%), 52 (30.1%), and 13 (7.5%) pts, respectively; 55 (31.8%) pts were asymptomatic, 58 (33.5%) ecchymotic, and 60 (34.7%) severely hemorrhagic.
The incidence (95% CI) of ITP was 0.85 (0.75, 0.96) per 100,000 inhabitants, increasing with age from 0.5 (0.43, 0.68) for pts 15–35y old to 2.4 (1.60, 3.51) for pts ≥75y old. Women had a higher incidence of ITP than men (1.2 [1.02, 1.37] vs 0.5 [0.43, 0.67]). Incidence of ITP varied with diagnosis stage (asymptomatic: 0.4 [0.31, 0.45]; ecchymosis: 0.1 [0.10, 0.19]; severe hemorrhage: 0.1 [0.06, 0.13]), and Algeria province (lowest in a public site in Tebessa: 0.1 [0.02, 0.92], highest in a public site in Sidi Bel Abbès: 1.6 [0.93, 2.89]). The prevalence (95% CI) of ITP was 5.7 (5.39, 5.93) per 100,000 inhabitants, increasing with age from 3.2 (2.78, 3.67) for pts 15–25y old to 11.9 (9.68, 13.08) for pts 65–75y old, and then decreasing to 7.6 (4.79, 12.06) for pts ≥85y old. Women had a higher prevalence of ITP than men (8.8 [8.33, 9.29]) vs 2.6 [2.34, 2.85]).
Corticosteroids were the primary treatment for new (136 [78.6%]) and previously (795 [80.7%]) diagnosed pts. Last/ongoing treatments at study inclusion were corticosteroids (712 [72.2%]), rituximab (56 [5.7%]), immunoglobulins (30 [3.0%]), TPO-RA (romiplostim: 19 [1.9%]), and antibacterials (4 [0.4%]). Among previously diagnosed pts, 172 (17.4%) had splenectomy with a median time of 19 months from ITP diagnosis.
Conclusion
The incidence and prevalence of ITP in Algeria increased with age, and both were higher in women than men, conforming to global trends. The results highlight the need to reduce corticosteroid treatment duration and improve second-line therapy options such as TPO-RAs before splenectomy (in line with the recently updated ASH and ICR guidelines) for management of adult ITP pts in Algeria.
Keyword(s): Epidemiology, Immune thrombocytopenia (ITP), Incidence, Prevalence