Zelie Guitton1, Louis Terriou1, Jean-Christophe Lega2, Raphaele Nove-Josserand2, Miguel Hie3, Zahir Amoura3, James B Bussel4, Mohamed Hamidou5, Eric Rosenthal6, Bertrand Lioger7, Dominique Chauveau8, Axel Chaminade9, Nadine Magy-Bertrand10, Marc Michel11, Sylvain Audia12, Bertrand Godeau11, Matthieu Mahevas11. 1. Département de Médecine Interne et Immunologie Clinique, CHU Lille, Lille, France. 2. Department of Internal Medecine, CHRU Lyon, Lyon, France. 3. Department of Internal Medicine, Pitie-Salpetriere University Hospital, Paris, France. 4. Weill Cornell Medicine, New York, NY, USA. 5. Department of Internal Medicine, Hôtel Dieu University Hospital, Nantes, France. 6. Weill Department of Medicine, Internal Medecine, CHRU Nice, Nice, France. 7. Department of Internal Medicine, Bretonneau University Hospital, Tours, France. 8. Department of Internal Medicine, CHRU Toulouse, Toulouse, France. 9. Hematology, CHRU Réunion, Saint-Pierre, France. 10. Internal Medecine, CHRU Besançon, Besançon, France. 11. Internal Medicine, French Referral Centre for Adult Immune Cytopenia, Henri Mondor Hospital, AP-HP, UPEC University, Créteil, France. 12. Department of Internal Medicine, Dijon University Hospital, Dijon, France.
Abstract
OBJECTIVES: The use of thrombopoietin-receptor agonists (TPO-RAs) has increased as a second-line therapy in ITP, but the efficacy and safety of such drugs has not been evaluated in SLE-associated ITP. METHODS: This was a multicentre retrospective cohort study from 2009 to 2016. Participating centres (n = 11) were secondary- or tertiary-care hospitals belonging to the French national network for adult ITP. RESULTS: We included 18 patients with SLE-ITP treated with TPO-RAs; 10 (55%) had aPL, 5 (27%) showing definite APS. Except for one patient, all (94%) achieved response with TPO-RAs overall. After a median follow-up of 14.7 months with TPO-RAs, four arterial thrombosis events (including one catastrophic APS) occurred in four patients. Two venous thrombosis events occurred in a patient without APS or aPLs. CONCLUSION: Our results suggest that aPLs should be systematically screened before TPO-RA initiation in patients with SLE. With aPL positivity, alternative therapy should be discussed (if possible), especially in patients with definite APS or suboptimal adherence to anti-coagulation therapy.
OBJECTIVES: The use of thrombopoietin-receptor agonists (TPO-RAs) has increased as a second-line therapy in ITP, but the efficacy and safety of such drugs has not been evaluated in SLE-associated ITP. METHODS: This was a multicentre retrospective cohort study from 2009 to 2016. Participating centres (n = 11) were secondary- or tertiary-care hospitals belonging to the French national network for adult ITP. RESULTS: We included 18 patients with SLE-ITP treated with TPO-RAs; 10 (55%) had aPL, 5 (27%) showing definite APS. Except for one patient, all (94%) achieved response with TPO-RAs overall. After a median follow-up of 14.7 months with TPO-RAs, four arterial thrombosis events (including one catastrophic APS) occurred in four patients. Two venous thrombosis events occurred in a patient without APS or aPLs. CONCLUSION: Our results suggest that aPLs should be systematically screened before TPO-RA initiation in patients with SLE. With aPL positivity, alternative therapy should be discussed (if possible), especially in patients with definite APS or suboptimal adherence to anti-coagulation therapy.