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ITP Patient Management and Important Treatment Factors

Panelists: Ivy Altomare, MD, Duke University Medical Center; Ralph V. Boccia, MD, FACP, LLC, Georgetown University Medical Center; Amit Mehta, MD Independent Hematology and Oncology Practice
Published: Tuesday, Jan 29, 2019



Transcript: 

Ivy Altomare, MD: Right. So, Dr Boccia, what do you think the biggest challenges are when you’re thinking about managing an ITP patient?

Ralph V. Boccia, MD, FACP, LLC: It’s probably a combination of the drug profile of the agents we’re going to use, the route of administration that we’re recommending, and the frequency of visits that the patient has to the clinic. So, just look at the TPO [thrombopoietin]–mimetics as an example where you have one that’s an oral agent that can be taken at home and you have a parenterally administered drug where there has to be an incident to charge for reimbursement.

And the patient theoretically has to come to the clinic every single week for an injection, so I think all of this kind of plays into your discussions with the patient. And then, of course, it’s the time course of the disease. So, are they in the acute phase, the persistent phase, or the chronic phase? How long have they been treated with agent X, Y, or Z? And are you at a point where you need to have a discussion about splenectomy?

I mean, we’re still struggling for that curative therapy and haven’t found it yet. Now we have some newer agents where it looks like the control of the disease will be significantly longer, and we have a fraction of patients that once they come off and will maintain their responses, but we still haven’t hit the bull’s-eye yet.

Ivy Altomare, MD: Yup. And this is maybe an unfair question because the treatment needs to be individualized. But just in general, what do you feel is the most important for treatment—rapid response, duration of response, or stability of platelet count—if you could just say in general?

Ralph V. Boccia, MD, FACP, LLC: I believe that it gets back to that, as Amit was talking about, the way a patient presents. So, is this somebody who has an acute bleed, profound thrombocytopenia, is already anemic, where you really do need a rapid response? Or is it someone who has a platelet count of 10,000? You know they can’t live at 10,000. They’ve got a little mucocutaneous bleeding. And so now you’ve got time. Is it somebody who’s acute enough that they end up in the hospital? Are they ending up in the ICU [intensive care unit]? So all of those factors play into the choices that you make, whether they’re single-agent, combination, and which.

Ivy Altomare, MD: Absolutely.

Transcript Edited for Clarity 

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Transcript: 

Ivy Altomare, MD: Right. So, Dr Boccia, what do you think the biggest challenges are when you’re thinking about managing an ITP patient?

Ralph V. Boccia, MD, FACP, LLC: It’s probably a combination of the drug profile of the agents we’re going to use, the route of administration that we’re recommending, and the frequency of visits that the patient has to the clinic. So, just look at the TPO [thrombopoietin]–mimetics as an example where you have one that’s an oral agent that can be taken at home and you have a parenterally administered drug where there has to be an incident to charge for reimbursement.

And the patient theoretically has to come to the clinic every single week for an injection, so I think all of this kind of plays into your discussions with the patient. And then, of course, it’s the time course of the disease. So, are they in the acute phase, the persistent phase, or the chronic phase? How long have they been treated with agent X, Y, or Z? And are you at a point where you need to have a discussion about splenectomy?

I mean, we’re still struggling for that curative therapy and haven’t found it yet. Now we have some newer agents where it looks like the control of the disease will be significantly longer, and we have a fraction of patients that once they come off and will maintain their responses, but we still haven’t hit the bull’s-eye yet.

Ivy Altomare, MD: Yup. And this is maybe an unfair question because the treatment needs to be individualized. But just in general, what do you feel is the most important for treatment—rapid response, duration of response, or stability of platelet count—if you could just say in general?

Ralph V. Boccia, MD, FACP, LLC: I believe that it gets back to that, as Amit was talking about, the way a patient presents. So, is this somebody who has an acute bleed, profound thrombocytopenia, is already anemic, where you really do need a rapid response? Or is it someone who has a platelet count of 10,000? You know they can’t live at 10,000. They’ve got a little mucocutaneous bleeding. And so now you’ve got time. Is it somebody who’s acute enough that they end up in the hospital? Are they ending up in the ICU [intensive care unit]? So all of those factors play into the choices that you make, whether they’re single-agent, combination, and which.

Ivy Altomare, MD: Absolutely.

Transcript Edited for Clarity 
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