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首页> 外文期刊>Journal of the advanced practitioner in oncology >Transitioning from Corticosteroid Treatment to Fostamatinib in Patients With Immune Thromborytopenla (ITP) Real-World Experience
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Transitioning from Corticosteroid Treatment to Fostamatinib in Patients With Immune Thromborytopenla (ITP) Real-World Experience

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Introduction: ITP is a rare hematologic disease that results in autoimmune-mediated destruction of platelets. Symptoms include bruising and bleeding with a potential for fatal hemorrhage as well as significant fatigue and decreased health-related quality of life. First-line ITP therapy typically involves corticosteroids, which are associated with adverse effects that include osteoporosis, weight gain, hypertension, and infection. Fostamatinib is a first-in-class oral spleen tyrosine ki-nase (SYK) inhibitor, FDA-approved for the treatment of adults with chronic ITP who have had an insufficient response to a prior therapy. Fostamatinib prevents phagocytosis of antibody-bound platelets by macrophages by targeting the intra-cellular SYK signaling pathway. We describe the real-world experience of 2 ITP patients who were treated with steroids, experienced adverse effects, and elected to transition to fostamatinib. Methods: Case #1: Female patient, diagnosed with ITP in 1980s. She had received multiple ITP therapies including steroids, IVIG, splenectomy, and ritux-imab. In early 2018, she developed influenza and then bruising with a platelet count of 20,000. She was given Solu-Medrol 1 g IV for 3 days and platelet count rose to 52,000. She was then placed on a prednisone taper. Two weeks later, her platelets were 244,000, but dropped quickly to 50,000. She was unwilling to take additional steroids or IVIG, and elected to start fostamatinib. Prednisone was simultaneously tapered over a 2-week period. Case #2: Female patient with a history of chronic ITP and metabolic syndrome. She had been trying to lose weight and lost 20 pounds in the prior 3 months. In April, 2018, her platelets were 30,000. She was given a Solu-Medrol pulse of 1 g IV daily for 3 days. Platelets rose to 50,000, and she started on prednisone 50 mg daily. One month later, her platelet count was 83,000. She chose to stop steroids due to weight gain, 35 pounds in one month (after starting the steroids), and elected to transition to fostamatinib. Results: Case #1: After starting fostamatinib lOOmg BID, platelets increased to 433,000 (Week 1) and 504,000 (Week 2) Fostamatinib was decreased to 100 mg QD. One month later, platelets were 562,000, and fostamatinib was discontinued. Off therapy response stabilized at >200,000 for >2 months. Case #2: Patient started fostamatinib 100mg BID and began tapering steroids over 4 weeks. Platelets rose to 183,000 over 2 weeks. She developed mild hypertension 4 weeks after starting fostamatinib, and her nebivo-lol was increased. She continued fostamatinib monotherapy, and the next two monthly platelet counts were 132,000 and 108,000 and have stabilized at >75,000. Conclusions: In a real-world setting, fostamatinib appears to be an effective treatment for patients with chronic ITP and allows tapering of steroids over a 2- to 4-week period. An off-therapy response was seen in 1 patient after discontinuing fostamatinib. Recommendations: Fostamatinib may be taken simultaneously while tapering corticosteroid therapy for ITP over a 2- to 4-week period and may be effective for patients with chronic ITP who are unresponsive or intolerant to steroid therapy.

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