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713 Avespa Study: Effectiveness and Safety of Avatrombopag in Immune Thrombocytopenia (ITP). a Real-World Study of the Spanish ITP Group (GEPTI)

Program: Oral and Poster Abstracts
Type: Oral
Session: 311. Disorders of Platelet Number or Function: Clinical and Epidemiological: Clinical Evidence in ITP
Hematology Disease Topics & Pathways:
Autoimmune disorders, Diseases, Immune Disorders
Monday, December 9, 2024: 11:30 AM

Maria Cristina Pascual Izquierdo, MD, PhD1,2*, Blanca Sanchez Gonzalez3*, Mariana Canaro Hinryk, MD4*, Gloria García-Donas Gabaldón5*, María Menor Gómez6*, Juan Jose Gil Fernandez7*, Silvia Monsalvo Saornil8*, Maria Teresa Alvarez Roman9*, Isidro Jarque10*, María José Llácer Ferrandis11*, Denis Zafra12*, Isabel Caparros Miranda13*, Ariana Ortúzar Pasalodos14*, Nuria Revilla15*, Jose Maria Bastida Bermejo, MD16*, Montserrat Alvarellos Outeiro17*, Reyes Jimenez Barcenas18*, Silvia Bernat Bernat19*, Esther Chica Gullón20*, Daniel Martinez Carballeira21*, Sunil Lakhwani22*, Elsa Lopez Ansoar, Hematologist MD23*, Esperanza Moreno Beltran24*, Alvaro Lorenzo Vizcaya, MD25*, Marta Canet Maldonado26*, Isabel Gonzalez y Gascon27*, Gonzalo Caballero Navarro28*, Amalia Cuesta29*, Begoña Pedrote30*, Maria Aranzazu Aguirre Arrizabalaga31*, Maialen Lasa Eguialde32*, Marta Moreno Carbonell, MD33*, Alicia Ortiz López34* and Eva Mingot Castellano35*

1Servicio de Hematología, Hospital Universitario Gregorio Marañón, Instituto de Investigación Gregorio Marañón, Madrid, Madrid, ESP
2Instituto de Investigación Gregorio Marañon, Madrid, Spain
3Hematology Department, Hospital del Mar, Barcelona, Spain
4Hematology Department., Hospital Universitario Son Espases, IdISBa., Palma, Spain
5Hospital Universitario Virgen Macarena, Sevilla, Spain
6Hospital Universitario Príncipe de Asturias, Madrid, Spain
7Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid., Madrid, Spain
8Hospital Universitario Puerta De Hierro, Majadahonda, Madrid., Madrid, Spain
9Hospital Universitario La Paz, Madrid, Spain
10Hematology Department, Hospital Universitari i Politècnic La Fe, Centro de Investigación Biomédica en Red de Cáncer – CIBERONC, Valencia, Spain
11Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
12Hospital Universitario 12 De Octubre, Madrid, Spain
13Hospital Universitario Virgen de la Victoria, Málaga., Malaga, Spain
14Hospital Universitario Rey Juan Carlos, Madrid, Spain
15Hospital Universitario Fundación Jiménez Diaz, Madrid, Spain
16Hospital Clínico Universitario de Salamanca, Salamanca., Salamanca, Spain
17Hospital Universitario de Navarra, Pamplona, Navarra., Pamplona, Spain
18Hospital de la Serranía de Ronda, Ronda, Málaga., Ronda (Málaga), Spain
19Hospital Universitario de La Plana, Villarreal, Castellón., Villarreal, CastellóN, ESP
20Hospital Universitario de Getafe, Getafe, Madrid., Madrid, Spain
21Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain, Oviedo, Spain
22Hospital Universitario de Canarias, La Laguna, Spain
23Department of Hematology and Hemotherapy, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
24Hospital Universitario Costa del Sol, Marbella, Málaga, Malaga, ESP
25Hospital Universitario Lucus Augusti, Lugo, Spain
26Hospital Universitari Mútua Terrassa, Terrassa, Barcelona., Barcelona, Spain
27Hospital Universitario Infanta Leonor, Vallecas, Madrid., Madrid, Spain
28Hematology Department. Hospital Miguel Servet, Zaragoza, Spain., Zaragoza, ESP
29Hospital Sierrallana, Torrelavega, Cantabria, Spain, Torrelavega, Spain
30Hospital Universitario Virgen del Rocío, Sevilla., Sevilla, Spain
31Hospital Universitario Donostia, Donostia, Gipuzkoa., San Sebasti N, Spain
32Hospital Universitario Donostia, Donostia, Gipuzkoa., Donostia, Spain
33Hospital General Universitario Gregorio Marañón, Madrid, Spain
34Hospital General Universitario Gregorio Marañón, Madrid., Madrid, Spain
35Hospital Universitario Virgen del Rocio, Sevilla, Spain

Background

Thrombopoietin receptor analogues (TPO-RAs) are recommended as second-line treatment for immune thrombocytopenia (ITP). Avatrombopag (AVA) is the last oral AR-TPO approved for use in Spain and also recommended for second-line use, for which few real-life data are currently available. Our objective is to evaluate the effectiveness and safety of AVA in severe and moderate/mild ITP patients, including those who have not responded to other treatments; to explore AVA's potential to reduce concomitant immunosuppressive therapies and compare its efficacy and safety in newly diagnosed/persistent ITP patients with those with chronic ITP.

Methods

The AVESPA study was a national, multicenter, retrospective study conducted by The Spanish ITP Group (GEPTI) of the Spanish Society of Haematology and Haemotherapy (SEHH). The study enrolled patients diagnosed with chronic, persistent, newly diagnosed ITP who began treatment with AVA from July 2022 to January 2024. The study assessed rates and time to response (R) (>50x109/L) and complete response (CR) (>100x109/L), duration of response (DOR), loss of response (LOR), adverse events (AEs), and treatment withdrawal before the end of follow-up. The calculations were performed for the entire cohort and in patients who initially presented with severe (<50x109/L), moderate (50-<100x109/L) or mild (>100x109/L) ITP. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Results

A total of 268 patients were recruited from 28 Spanish hospitals and were followed for a median of 47 months (interquartile range of 30.4-58.9 months). Median age was 59.3 years, and 57.8% patients were female. ITP primary was diagnosed in 227 patients (85,3%). When AVA treatment started, 193, 46 and 29 had severe (platelet count [PC] <50x109/L), moderate (50-<100x109/L) and mild (>100x109/L) ITP, respectively. Prior to switching to AVA 197 (73%) and 106 (40%) patients had used >2 and >3 lines of treatment, respectively.

In the severe ITP group, 154/193 (79.8%) and 20/193 (10.4%) patients achieved complete response (CR, [PC>100x109/L) and response (R, PC>50x109/L), respectively. Among 129 severe ITP patients who were still on AVA at their last visit, 87(67.4%) and 26(20.1%) had CR and R, respectively.

Results were similar in the 104 severe ITP patients who switched to AVA due to previous treatment failure. Severe ITP patients reached R and CR in 13 (7-21) and 14 (9-35) days, respectively. Eighty-seven percent of moderate ITP patients reached CR while 93% of mild ITP patients showed PC >100x109/L. LOR was always <10%, regardless of ITP severity. The duration of ITP did not significantly influence the response. Among the 147 severe ITP patients who switched to AVA due to previous treatment failure, age and sex did not significantly affect the response to AVA.. A significant, inverse correlation was observed between the number of previous treatment lines and the best response achieved (Rho = -0.230, P = .002). Accordingly, the proportion of patients reaching response or CR was decreasing as the number of previous treatment lines increased, and was significantly higher when patients had received less than 4 treatment lines

Ninety-one percent (39/43) of heavily pretreated (>4 lines) severe ITP patients who had previously failed treatment achieved a platelet count of >50x109/L after switching to AVA.. Previous use of eltrombopag and/or romiplostim did not impact the response, regardless of whether the previous TPO-RA(s) treatment had succeeded or failed. In 80.0% of severe ITP patients, AVA allowed for the reduction or suspension of corticosteroid doses.

In terms of safety, 175/268 (65%) patients did not experience any AE, and 40/268 (15%) discontinued treatment after reaching counts >400x109/L. Nine cases of thromboses were documented, none of which were fatal, and three occurred in patients who developed thrombocytosis. The remaining AEs were mild and transient. At the end of follow-up, 185/268 (69%) patients were still on AVA treatment.

Conclusion

AVESPA study included the largest cohort of patients treated with AVA in real life. Our findings were aligned with those of previous trials and real-world evidence. AVA can increase platelet counts above baseline in >90% of ITP patients, regardless of severity of the condition. This increase typically occurs within the first 2 weeks of treatment, while also maintaining a low rate of severe adverse events.

Disclosures: Canaro Hinryk: Novo Nordisk, Takeda, Roche, Pfizer, Octapharma, Amgen, Novartis, CSL Behring and Sobi: Honoraria; Novo Nordisk, Takeda, Roche, Pfizer, Octapharma, Amgen, Novartis, CSL Behring and Sobi: Speakers Bureau. Alvarez Roman: Novo Nordisk, Takeda, Roche, Pfizer, Octapharma, Amgen, Novartis, CSL Behring and Sobi: Honoraria; Novo Nordisk, Takeda, Roche, Pfizer, Octapharma, Amgen, Novartis, CSL Behring and Sobi: Speakers Bureau. Jarque: BeiGene: Research Funding; Incyte: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Regeneron Pharmaceuticals, Inc.: Research Funding; Gilead: Honoraria; Grifols: Honoraria; Takeda: Consultancy, Honoraria, Research Funding; Sobi: Consultancy, Honoraria, Research Funding; Pfizer: Consultancy; Novartis: Consultancy; Kyowa Kirin: Consultancy; AstraZeneca: Consultancy, Honoraria, Research Funding; Amgen: Consultancy, Research Funding. Bastida Bermejo: NovoNordisk, Sobi, CSL Behring, Rovi, Novartis, Takeda, Roche, Janssen, Stago; Scientific: Honoraria; Novartis, Sobi, Roche, CS: Speakers Bureau. Jimenez Barcenas: Sobi: Honoraria; Roche: Honoraria; Pfizer: Honoraria; Novo Nordisk: Honoraria; Grifols: Honoraria; CSL Behring: Honoraria; Amgen: Honoraria.

*signifies non-member of ASH