Unmet needs in the management of immune-mediated thrombotic thrombocytopenic purpura and the potential role of caplacizumab in the UK-A modified-Delphi study.
Author
Scully, MarieDutt, Tina
Lester, Will
Farrington, Emily
Lockwood, Stevie
Perry, Richard
Holmes, Steve
Publication date
2022-04-28Subject
Haematology
Metadata
Show full item recordAbstract
Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is an ultra-rare, blood-clotting disorder. Management historically relies on plasma exchange and immunosuppression; however, a 10%-20% mortality rate is still observed. Caplacizumab binds to von Willebrand factor and directly inhibits platelet aggregation; addition of caplacizumab to historical treatment induced faster resolution of platelet count in clinical trials. In 2019, a modified-Delphi study was conducted with UK experts, to develop consensus statements on management of acute TTP and the potential role of caplacizumab. An unmet need was acknowledged, and areas requiring improvement included: time to diagnosis and treatment initiation; time to platelet normalisation (TTPN) during which patients remain at risk of persistent microvascular thrombosis and organ damage; and incidence of subsequent exacerbations and relapses. Caplacizumab addition to historical treatment within 24 h (after confirmatory ADAMTS13 [a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13] assay) would significantly reduce TTPN, which directly influences acute outcomes, with manageable bleeding risk and reduced burden on healthcare systems. Expert panellists agree that poor outcomes in iTTP largely result from failure to rapidly control microvascular thrombosis. Use of caplacizumab during a confirmed iTTP episode could offer better control and may plausibly improve long-term outcomes. However, this consensus must be validated with further clinical trials and robust real-world evidence.Citation
Scully M, Dutt T, Lester W, Farrington E, Lockwood S, Perry R, Holmes S. Unmet needs in the management of immune-mediated thrombotic thrombocytopenic purpura and the potential role of caplacizumab in the UK-A modified-Delphi study. EJHaem. 2022 Apr 28;3(3):619-627. doi: 10.1002/jha2.435Type
ArticleAdditional Links
https://onlinelibrary.wiley.com/journal/26886146DOI
10.1002/jha2.435PMID
36051029Journal
eJHaemPublisher
Wileyae974a485f413a2113503eed53cd6c53
10.1002/jha2.435