PF711 DIFFERENCES IN PERCEPTIONS ON TREATMENT APPROACHES BETWEEN PHYSICIANS AND ITP PATIENTS: RESULTS FROM THE ITP WORLD IMPACT SURVEY (I‐WISH)
Authors: Kruse A. , Kruse C. , Morgan M. , Bussel J. , Provan D. , Ghanima W. , Hou M. , Santoro C. , Michel M. , Lovrencic B. , Waller J. , Stankovic M. , Tomiyama Y. 
Published: June 2019

Background:

Guidelines recommend that adult patients (pts) with persistent or chronic immune thrombocytopenia (ITP) who are corticosteroid (CS) dependent or unresponsive to 1st‐line CS therapy be treated with splenectomy, rituximab, or a thrombopoietin receptor agonist (TPO‐RA).

Aims:

I‐WISh studied the burden of ITP and its quality of life impact using a global pts and physicians (MDs) sampling frame. MDs and ITP pts beliefs, perceptions, and attitudes about treatment are reported.

Methods:

I‐WISh is a cross‐sectional survey of 1507 ITP pts and 472 MDs across 13 countries; pts were recruited via MDs and pt support groups. The survey captured demographics, signs and symptoms, impact of symptoms, and pt–MD relationships. An expert MD and pt advocacy ITP specialist steering committee designed and endorsed the survey materials.

Results:

MDs mean no. of current and newly diagnosed ITP pts (SD) in the past year were 34 (50) and 18 (36), respectively. Pts were provided with a list of treatments and selected all that applied to them. Amongst treatments pts received at any time, CSs (79%) were the most common, followed by intravenous immunoglobulin (IVIg; 48%), other immunosuppressants (ISs; 15%), Rho[D] immune globulin (anti‐D; 13%), and cyclosporine (10%). TPO‐RAs and anti‐CD20 were used overall in 30% and 26% of pts, respectively. More pts used a TPO‐RA (17%) compared with anti‐CD20 (5%), whilst 26% of pts used CSs at the time of survey. MDs were more likely to prescribe CSs over TPO‐RAs across the platelet level <10–100 × 103/μL and 1st and 2nd relapses. TPO‐RAs and anti‐CD20 s were most likely to be prescribed after a 2nd (57% vs 52%) or 3rd relapse (60% vs 48%) (Fig). In choosing treatments, MDs and pts prioritized the ability to offer sustained remission (82% vs 90%), reduction in bleeding risk (86% vs 87%), fewer side effects (76% vs 86%), and avoidance of immunosuppression (61% vs 72%). TPO‐RAs were preferred by 32% of MDs for achieving sustained remission compared with splenectomy (26%), CSs (24%), anti‐CD20 (12%), or IVIg (6%). MDs estimated treatment success by achieving lasting remission occurred in 50% of TPO‐RA pts, and in 52% and 48% of splenectomy and CS pts, respectively. This was 42% and 32% in anti‐CD20 s and IVIg pts respectively. Pts rated their agreement with statements regarding the effectiveness of their current treatment on a 7‐point Likert scale where 7 = strongly agree. Scores ≥5 were banded to indicate agreement with the statement; 84% of pts on a TPO‐RA indicating they agreed that TPO‐RAs were effective at preventing bleeding. This was lower for anti‐CD20 and CSs pts (74% and 66% respectively). Most pts felt their current treatment was effective in treating ITP symptoms (TPO‐RA 78%; anti‐CD20 83%; CSs 63%; IVIg 70%). Beyond bleeding, symptoms reported by pts taking medication included fatigue (50%), anxiety surrounding unstable platelet count (32%), bruising occurring for unknown reason (30%). Immunosuppressive effect was a pt concern for CSs (64%), anti‐CD20 (56%), and IVIg (42%). With TPO‐RAs, 86% of pts valued prevention of immunosuppression and 5% disagreed. Overall satisfaction with control was perceived by 76% of pts on TPO‐RAs, 78% on anti‐CD20, 69% on IVIg, and 52% on CSs pts. 38% of pts agreed on overall satisfaction with splenectomy.

Summary/Conclusion:

Pts perceived TPO‐RAs and anti‐CD20 s to be similarly effective in treating ITP symptoms, with high overall satisfaction, whereas satisfaction with splenectomy was lower. ISs were used infrequently. CSs were the most common treatment pts used since diagnosis.

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