Treatment Patterns and Responses in Adult Primary Immune Thrombocytopenia Patients: A Single-Centre Study

Abstract

Objective: This study aimed to characterize real-world treatment patterns and outcomes of adults with primary immune thrombocytopenia (ITP) treated at a tertiary care hospital.

Methods: We retrospectively analyzed electronic medical records of 56 adult patients with primary ITP. Platelet count changes following treatment were assessed using the Wilcoxon signed-rank test. Multiple linear regression was used to identify predictors of treatment response, including age, sex, baseline platelet count, comorbidities, and blood group. Treatment response was defined as a platelet count ?50 × 10?/L or a doubling of baseline platelet count.

Results: Our study included 56 adult patients with primary ITP with mean age 37.25± 16.37 years. Male were  21 (37.5%) and female  35 (62.5%). After first-line therapy, median pre-treatment platelet count 40 × 10?/L (range 8–92) increased to 98 × 10?/L (range 30–210), p <0 .001. The overall response rate was 82%. After second-line therapy, median pre-treatment platelet count 52.5 × 10?/L (range 10–85) increased to 94 × 10?/L (range 45–180), p < .005. The overall response rate was 75%. After third-line therapy, median pre-treatment platelet count 40 × 10?/L (range 25–55) increased to 101 × 10?/L (range 70–150), p = 0.12. Response rate was 67%. Regression analysis identified older age (B = 1.92, p = 0.004) and blood group B (B = 10.60, p = 0.01) as predictors of favorable response, whereas higher baseline platelet count (B = –0.77, p = 0.008) and presence of comorbidities (B = –48.930, p =0.01) were associated with poorer outcomes. Sex was not a significant predictor.

Conclusion: This single-center study underscores the stepwise treatment approach for ITP: corticosteroids followed by thrombopoietin receptor agonists and splenectomy. Patient-specific factors such as age, baseline platelet count, comorbidities, and blood group may help tailor individualized treatment strategies. Larger, prospective studies are warranted to validate these findings.

Keywords: Purpura, Thrombocytopenic, Idiopathic; Platelet Count; Corticosteroids/therapeutic use; Eltrombopag/therapeutic use; Azathioprine/therapeutic use; Splenectomy; Thrombopoietin Receptor Agonists; Treatment Outcome; Retrospective Studies; Predictive Value of Tests