Living With ITP

Platelets are only one dimension of ITP^1-3

ITP is a complex disease with potential ramifications beyond low platelet counts and the associated bleeding symptoms—including inflammation and its potential effects, and impacts on quality of life (QOL).

Ongoing research continues to support the presence of inflammation in patients with ITP³

Systemic inflammation in ITP is suggested by the presence of elevated inflammatory markers, including^4-6:

• TNF-α
• IL-6
• NLRP3 inflammasome
• IFN-γ

ITP affects the whole patient, not just their platelets^1,7,8

In the Immune Thrombocytopenia World Impact Survey (I-WISh)* of 1507 patients with ITP and 472 HCPs:

^*I-WISh was an online, cross-sectional survey of patients with ITP and hematologists or hemato-oncologists who treat patients with ITP in 13 countries. The patient questionnaire collected information on demographics and diagnosis, symptoms of ITP, health-related quality of life (HRQOL) and emotion associated with ITP, impact of ITP on work, finances, and support, treatment received, and patient and physician relationship. The physician survey comprised 6 sections that collected information on demographics, diagnosis of ITP and patient caseload, symptoms of ITP, impact of ITP on aspects of patients’ physical, emotional, HRQOL, social health, treatment patterns, and patient and physician relationship. There were 2 questions about the emotional impact of ITP and the responses were based on a 7-point Likert scale (1 = never, 7 = a great deal). There was 1 additional question on the need for professional support.¹

Fatigue can be a major burden for patients with ITP⁹

In I-WISh, 1507 patients rated functional, psychological, and emotional aspects of their condition on a 7-point Likert scale, with a score of 5-7 indicating the greatest impact. In the survey^1,9:

reported fatigue at diagnosis (n=870/1507).⁹ Of those,

rated that fatigue as severe (n=637/870)⁹

But HCPs may not perceive patients’ fatigue at the same levels⁹

Of the HCPs surveyed in I-WISh:

reported hearing about fatigue at diagnosis (n=472) and rated⁹

of that fatigue as severe (n=465)⁹

Patients with ITP might also suffer from cerebral microbleeds (CMBs) and cognitive impairment^10,11

In a 2020 study in Blood,^†

^†A cross-sectional prospective study of 49 patients with ITP and nadir platelet counts <30,000/μL and 18 age-matched healthy controls that used susceptibility-weighted magnetic resonance imaging (MRI) to detect CMBs as a marker of occult hemorrhage.¹⁰

Based on these preliminary data, CMBs were associated with lower platelet count and longer disease duration. The strong association between CMBs and ITP duration could indicate that CMBs may accumulate over time.¹⁰

In a 2022 study in Blood,^‡

^‡ A total of 69 patients completed the Cambridge Neuropsychological Test Automated Battery (CANTAB) to assess episodic memory, executive function, processing speed, working memory, and attention.¹¹

Many patients with ITP exhibit impairments in attentional function at least as severe as those observed in patients of similar age with mild traumatic brain injury, chronic fatigue syndrome, or moderate-severe depressive disorder.¹²

Patients are worried about their ITP¹

^§ A limited number of population-based studies have reported that the rate of death among patients with ITP is comparable to the general population in patients younger than age 60. Mortality is higher than the general population in older patients and patients with comorbidities.^13,14

Next: Future of ITP

There is an unmet need for ITP treatments that deliver rapid and durable improvements in platelet counts, bleeding symptoms, and patient QOL.^15,16