Paradigm shift in ITP treatment patterns in the era of the COVID-19 pandemic -opportunity to study real world outcomes from an established platform: Update from UK Adult ITP registry

ABSTRACT

Background: The SARS-CoV- 2 pandemic has led to changes in the way we manage autoimmune disease such as immune thrombocytopenia (ITP). Immunosuppression is a risk factor for severe COVID-19 and also leads to reduced vaccine responses. Medical therapy for ITP is broadly divided into immunosuppressive or that which stimulates megakaryopoeisis. Aim(s) To assess changes in medical therapy for ITP during the SARS-CoV- 2 pandemic using data from the UK adult ITP registry Methods: The UK registry of primary adult ITP (https//www.qmul. ac.uk/itpre gistr y/), one of the largest internationally, produces annual treatment reports on therapy use, trends and to identify cohorts for study. We reviewed data from annual reports to assess treatment changes. Result(s) At the time of analysis, there were 4503 patients in the registry 224 diagnosed with ITP in 2019, 105 in 2020 and 97 in 2021 (median age 57y, 59y and 55y respectively). Table 1 shows changes in treatment 2019-2021. Most patients still received steroids as part of the treatment for ITP acutely. IVIG use remained static between 2019 and 2021. For diagnoses made between 2019 and 2021 all patients received at least 1 treatment. Immunosuppressive therapy use reduced from pre-2019 levels (data not tabulated) where almost 23% patients received rituximab and 18% MMF to 0% and 3% respectively by 2021. Use of TPO-RA increased, from 33% in 2019 to 43% in 2021. Median time to starting TPO-RA was 3.76 months (IQR 1.317,9.225) in 2019 reducing to 0.985 months (IQR 0.58,1.465) in 2021. Platelet response criteria will undergo analysis once additional data entry has taken place. Conclusion(s) Steroids continue to be used acutely for most ITP patients but TPO-RA are being used ahead of other immunosuppressive therapy in line with interim NHSE pandemic policy. Most patients entered received at least one line of treatment -likely reflecting those frequently attending sites to access healthcare.