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2668 Higher Symptom Burden in Patients with Immune Thrombocytopenia Experiencing Fatigue: Results from the ITP World Impact Survey (I-WISh)

Program: Oral and Poster Abstracts
Session: 311. Disorders of Platelet Number or Function: Poster III
Hematology Disease Topics & Pathways:
Biological, Adult, Diseases, Non-Biological, Bleeding and Clotting, Combinations, Therapies, ITP, Study Population, Clinically relevant
Monday, December 7, 2020, 7:00 AM-3:30 PM

James B. Bussel1, Waleed Ghanima2, Nichola Cooper, MD3, Alexandra Kruse4*, Caroline Kruse4*, Yoshiaki Tomiyama5, Ming Hou6, Cristina Santoro7*, Serge Laborde8*, Mervyn Morgan9*, Barbara Lovrencic10*, Tom Bailey, MSci11*, Jens Haenig12* and Drew Provan13*

1Division of Hematology/Oncology, Weill Cornell Medical College, New York, NY
2Department of Medicine, Østfold Hospital Trust, Kalnes, Norway
3Hammersmith Hospital, Imperial College London, London, United Kingdom
4Platelet Disorder Support Association, Cleveland, OH
5Osaka University Hospital, Osaka, Japan
6Department of Hematology, Qilu Hospital of Shandong University, Jinan, China
7Hematology, University Hospital Policlinico Umberto I, Rome, Italy
8O’Cyto, Saint Loubès, France
9ITP Support Association, Bolnhurst, United Kingdom
10Italian Association for Immune Thrombocytopenic Purpura, Caprino Veronese, Italy
11Adelphi Real World, Bollington, United Kingdom
12Novartis Pharma AG, Basel, Switzerland
13Barts and The London School of Medicine and Dentistry, London, United Kingdom

Background: Fatigue is common in patients (pts) with immune thrombocytopenia (ITP) and impacts quality of life (QoL). To improve clinical management of ITP, it is critical to understand the relationship between fatigue and pt characteristics, i.e. age, gender, duration of ITP, symptoms, platelet count, and therapy.

Aims: The ITP World Impact Survey (I-WISh) cross-sectional survey studied the burden of ITP and its impact on QoL using a global pt and physician (MD) sampling frame from 13 countries. This subanalysis explored prevalence of ITP symptoms in those pts reporting fatigue at diagnosis or at time of survey and any associations between last platelet count and fatigue severity at time of survey by gender. It also compared the social impact of ITP in pts with and without fatigue at time of survey.

Methods: Participating MDs (N = 472) were required to be actively managing ITP pts (minimum 3 pts in past 12 months). Pts (N = 1507) were recruited via MDs and pt advocacy groups (PAGs). Pts and MDs completed a 30-min online survey on demographics, ITP signs and symptoms, impact of symptoms, and pt–MD relationships. ITP expert MDs and PAG representatives designed and endorsed the survey.

Results: Mean pt age was 47 yrs, and 65% were female. At time of survey, 46% of pts selected fatigue as one of their 3 most bothersome ITP symptoms. A majority of pts reported fatigue at diagnosis (58%) or time of survey (50%). Most pts rated the severity of fatigue with a score of 5-7, where 7 represents ‘worst imaginable’, at diagnosis (73%) and at time of survey (65%); MDs perceived fatigue less frequently either at diagnosis (30%) or as a common ITP symptom (31%). Pts who experienced fatigue at diagnosis and at time of survey reported a higher prevalence of ITP symptoms compared with those who did not. The largest differences between pts with and without fatigue (≥ 20%) were observed at diagnosis (data not shown) and time of survey (Fig.1A) for depression, anxiety around platelet count, and headache. Overall, symptom burden at diagnosis and time of survey was similar, irrespective of gender, amongst pts who reported fatigue at diagnosis (differences < 10%); the exception was moderate-to-severe headache, reported more frequently by females at diagnosis (37% vs 19%) and time of survey (28% vs 13%). Bleeding from cuts and anxiety around unstable platelet count were also more frequent at diagnosis in females (45% vs 32%, and 50% vs 37%, respectively). No pattern was observed between improved platelet count and decreased reporting of fatigue (Fig.1B).

Increased frequencies of depression and anxiety around unstable platelet count were observed in pts experiencing fatigue at time of survey vs those who did not, with more females than males experiencing fatigue also reporting depression (33% vs 25%). A bigger impact of ITP on social life was experienced by pts who reported fatigue at time of survey than those who did not (29% vs 14% reported ITP impact on social life ‘more than half of the time’ or ‘all the time’).

Conclusion: Pts reporting fatigue either at diagnosis or time of survey also had an overall increased symptom burden with disabling effects on QoL. Pts reporting fatigue had increased prevalence of depression and anxiety vs those who did not, at both timepoints. As described recently in other studies, no clear correlation was identified between fatigue and last platelet count or treatment at time of survey. Fatigue is an important part of ITP, but it may have a distinct underlying pathophysiology not directly linked to platelet count, e.g. platelet response to treatment.

This abstract has been previously presented at the 25th Congress of the European Hematology Association (EHA), Virtual Congress, June 11-21, 2020.

Disclosures: Bussel: UCB: Consultancy; Shionogi: Consultancy; Argenx: Consultancy; Novartis: Consultancy; Amgen: Consultancy; RallyBio: Consultancy; Momenta: Consultancy; Dova: Consultancy; 3SBios: Consultancy; Regeneron: Consultancy; Principia: Consultancy; Rigel: Consultancy; CSL Behring: Consultancy. Ghanima: Pfizer: Honoraria, Research Funding, Speakers Bureau; Bristol Myers Squibb: Research Funding; Bayer: Research Funding; Principia: Honoraria, Speakers Bureau; Amgen: Honoraria, Speakers Bureau; Novartis: Honoraria, Speakers Bureau. Cooper: Amgen: Honoraria, Speakers Bureau; Novartis: Honoraria, Speakers Bureau. Kruse: Principia: Other: Grant paid to PDSA; Rigel: Other: Grant paid to PDSA; UCB: Other: Grant and consultancy fee, all paid to PDSA; CSL Behring: Other: Grant paid to PDSA; Pfizer: Other: Grant and consultancy fee, all paid to PDSA; Argenx: Other: Grant paid to PDSA; Novartis: Other: PDSA received payment for recruiting patients to I-WISh and for promoting I-WISh on the globalitp.org website. Grant and consultancy fee, all paid to PDSA outside the submitted work; Amgen: Other: Grant and honorarium, all paid to PDSA. Tomiyama: Sysmex: Consultancy; Kyowa Kirin: Honoraria; Novartis: Consultancy, Honoraria. Santoro: Amgen: Honoraria, Speakers Bureau; Novartis: Honoraria, Speakers Bureau; Takeda: Honoraria, Speakers Bureau; CSL Behring: Honoraria, Speakers Bureau; Bayer: Honoraria, Speakers Bureau; Novo Nordisk: Honoraria, Speakers Bureau; Sobi: Honoraria, Speakers Bureau; Roche: Honoraria, Speakers Bureau. Morgan: Sobi: Other: Consultancy fees paid to the ITP Support Association; UCB: Other: Consultancy fees paid to the ITP Support Association; Novartis: Other: Consultancy fees paid to the ITP Support Association. Lovrencic: UCB: Other: Consultancy fees paid to AIPIT; Novartis: Other: Honorarium paid to AIPIT. Bailey: Adelphi Real World: Current Employment; Novartis: Other: Employee of Adelphi Real World, which has received consultancy fees from Novartis. Haenig: Novartis: Current Employment. Provan: ONO Pharmaceutical: Consultancy; MedImmune: Consultancy; Amgen: Honoraria, Research Funding; UCB: Consultancy; Novartis: Honoraria, Research Funding.

*signifies non-member of ASH