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    Home > Active Ingredient News > Blood System > Quality upgrade, live up to trust, help ITP patients live at ease

    Quality upgrade, live up to trust, help ITP patients live at ease

    • Last Update: 2021-10-10
    • Source: Internet
    • Author: User
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    Primary immune thrombocytopenia (primary immune thrombocytopenia, ITP) is an acquired autoimmune disease characterized by thrombocytopenia, and one of the most common clinical bleeding diseases [1]
    .

    In recent years, with the continuous advancement of the "patient-centered" medical model, patients are encouraged to participate in treatment decision-making, taking into account the wishes of patients, improving the platelet count to a safe level on the basis of minimizing adverse effects of treatment, reducing bleeding events, and paying attention to the health-related life of patients Quality (HRQoL) has become the basic principle of ITP treatment [1]
    .

    The oral platelet-promoting drug Eltroipopag has been proven to maintain a safe and stable platelet count for a long time, reduce the risk of bleeding, and improve health-related quality of life, and the Chinese subgroup of the ITP Global Impact Survey (I-WISh) analyzes what both Chinese doctors and patients believe The most important treatment goals of ITP are highly compatible, so that ITP patients no longer need to be vigilant at all times, worry about bleeding, and support ITP patients to return to society, work normally, and live without restraints [2]
    .

    The efficacy of Itrobopar is highly compatible with the most important treatment goals of ITP considered by both doctors and patients.
    An I-WISh Chinese subgroup analysis involving 102 doctors and 286 patients with ITP shows that both doctors and patients believe that they reduce spontaneous blood and maintain safety and stability.
    Blood platelet levels and improving quality of life are the three most important treatment goals for ITP (Figure 1)
    .

    Figure 1 I-WISh survey of the three most important treatment goals of ITP by both doctors and patients.
    The I-WISh China subgroup survey shows that fatigue and anxiety about the unstable platelet count are the main factors that bother patients (Figure 2), exceeding 90.
    0% Of patients believe that ITP has a negative impact on their work or study, daily affairs, exercise ability, etc.
    After undergoing treatment, anxiety about platelet count fluctuations is the most significant symptom reported by ITP patients, and 74.
    8% of patients report This more serious concern fully reflects the needs of patients for stable platelet counts and improved quality of life [2]
    .

    Figure 2 Common symptoms after ITP treatment Most patients believe that thrombopoietin receptor agonists (TPO-RA) can effectively prevent bleeding events (88.
    1%), relieve symptoms (75.
    2%) and improve physical fitness (72.
    0%), 83.
    9% Of domestic patients are satisfied with the overall efficacy of TPO-RA treatment [2]
    .

    The treatment options of doctors are slightly different.
    If the goal is to continue to be effective, 55.
    9% (57/102) of doctors will choose glucocorticoids, and only 15.
    7% (16/102) of doctors will choose TPO-RA
    .

    Eltroipopag is currently the only oral TPO-RA drug recommended in the Chinese Adult ITP Diagnosis and Treatment Guidelines [1]
    .

    The randomized double-blind placebo-controlled study RAISE, the open-label study EXTEND, and many evidence-based medical evidences show that: Eltrobopar can maintain a safe platelet level for a long time, significantly reduce the risk of bleeding, improve health-related quality of life, and help patients with ITP work with peace of mind , Life [2-4]
    .

    Eltrodopag significantly reduces the risk of bleeding.
    During the 6-month treatment of the RAISE study, the Eltrodopag group had a 65% reduction in the chance of clinically significant bleeding (WHO Grade 2-4) compared with the placebo group (p=0.
    0008) ) (Figure 3) [3]
    .

    In the EXTEND study, the overall bleeding rate decreased after treatment with Eltroipopag, and the bleeding symptoms (WHO Grade 1-4) decreased from 57% at baseline to 16% at 1 year, and continued to decrease in the course of several years of medication Bleeding [4]
    .

    Figure 3 Proportion of patients with clinically significant bleeding (WHO Grade 2-4) in the RAISE study.
    Eltroipopag maintains a safe and stable platelet count for a long time.
    ITP International Expert Consensus 2019 recommends that patients with symptomatic ITP should maintain a stable platelet level at 20-30x109/L Above [5]
    .

    In the two studies of RAISE and EXTEND, the median platelet count of the patients in the Eltropopag group remained above 50x109/L during the period of 2 weeks of treatment until the end of the treatment [3-4]
    .

    The EXTEND study is currently the largest long-term efficacy and safety data of TPO-RA for ITP, and the platelet count has been maintained above a safe level for a long time for up to 8.
    76 years [4]
    .

    Figure 4 The number of weeks of continuous response in ITP patients with platelet count ≥30x109/L or ≥50x109/L and twice the baseline.
    Eltrodopag significantly improved the health-related quality of life of ITP patients.
    Among the eight dimensions of the patient's SF-36v2 scale, the scores of five dimensions of physiological function, physiological function, vitality, social function and emotional function, SF-36v2 total score and FACT-Th6 score were significantly improved compared with baseline (Figure 5).
    However, patients in the placebo group did not improve [3]
    .

    Figure 5 The average change in SF-36v2 and FACT-Th6 scores from baseline.
    Note: The p-value is the change in scores from baseline to week 26 for each treatment group
    .

    FACT-Th6, a six-item short form for evaluating thrombocytopenia in cancer treatment function; SF-36v2, the second edition of the Concise Health Measurement Scale
    .

    The HRQoL evaluation results of 302 ITP patients in the EXTEND study showed that during the treatment of ITP, the fatigue (FACIT-F) score and function (FACT-Th6) score of ITP patients began to improve within 3 months and lasted for nearly 5 years.
    (P<0.
    05 at almost all time points)
    .

    The overall physical health (SF-36v2 PCS) score has continued to improve for 2.
    5 years (Figure 6)
    .

    In summary, continuous treatment with Eltroipopag can significantly improve the quality of life of patients with ITP, including alleviating fatigue and improving physical function [6]
    .

    Figure 6 HRQoL of 302 patients with ITP in the EXTEND study Note: FACIT-Fatigue, cancer treatment function assessment fatigue scale score; FACT-Th6, cancer treatment function assessment thrombocytopenia 6 short form; SF-36, concise health measurement scale ; MEI-SF, motivation and vitality score; PCS, general physical health review; MCS, general mental health review Conclusion ITP is a chronic disease with a continuous risk of bleeding.
    Reasonable treatment methods can help improve the prognosis of patients and improve the lives of patients Quality [2]
    .

    I-WISh China subgroup survey shows that despite treatment, Chinese ITP patients still have a high unmet need for long-term stable platelet count and improvement of quality of life.
    Most patients are satisfied with the overall efficacy of TPO-RA treatment.
    Therefore, China Doctors can increase the use rate of TPO-RA
    .

    Eltroipopag is currently the only oral TPO-RA drug recommended in the Chinese Adult ITP Diagnosis and Treatment Guidelines [1]
    .

    RAISE, EXTEND, and other clinical studies have shown that Eltropolox can maintain a safe and stable platelet count for a long time, reduce bleeding risks, and improve the health-related quality of life of patients.
    It is highly compatible with the most important treatment goals of ITP considered by both doctors and patients in the I-WISh survey.
    , To meet the treatment needs of patients in all aspects, and help patients return to normal work and life
    .

    Although ITP patients have the highest overall satisfaction with TPO-RA treatment, the treatment methods Chinese doctors tend to use are different from the best treatment methods reported by patients
    .

    It indicates that in future treatment, both doctors and patients need to communicate with each other, make joint decisions, and adjust treatment measures in a targeted manner to maximize the benefits of patients
    .

    References: [1] Hou Ming, Hu Yu.
    Chinese Guidelines for the Diagnosis and Treatment of Adult Primary Immune Thrombocytopenia (2020 Edition)[J].
    Chinese Journal of Hematology, 2020(8):617-623.
    [2] Wang Ruting, Liu Xinguang, Hou Yu et al.
    A doctor-patient survey on primary immune thrombocytopenia: I-WISh international survey and subgroup analysis in China[J].
    Chinese Journal of Hematology, 2021, 42(5):369 -375.
    [3] Cheng G, Saleh MN, Marcher C, et al.
    Eltrombopag for management of chronic immune thrombocytopenia (RAISE): a 6-month, randomised, phase 3 study[J].
    Lancet, 2011, 377(9763 ):393-402.
    [4] Wong R, Saleh MN, Khelif A, et al.
    Safety and efficacy of long-term treatment of chronic/persistent ITP with eltrombopag: final results of the EXTEND study[J].
    Blood, 2017 , 130(23):2527-2536.
    [5] Provan D, Arnold DM, Bussel JB, et al.
    Updated international consensus report on the investigation and management of primary immune thrombocytopenia[J].
    Blood Advances, 2019, 3(22 ):3780-3817.
    [6] Khelif A, et al.
    Am J Hematol.
    2019, 94(2):200-208.
    The content of this article is for reference only by medical and health professionals
    .

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