Rituximab or cyclosporin in refractory immune thrombocytopenia secondary to connective tissue diseases: a real-world obs
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BRIEF REPORT
Rituximab or cyclosporin in refractory immune thrombocytopenia secondary to connective tissue diseases: a real-world observational retrospective study Fangfang Sun 1 & Jie Chen 1 & Wanlong Wu 1 & Shikai Geng 1 & WenWen Xu 1 & Shuhui Sun 1 & Zhiwei Chen 1 & Liyang Gu 1 & Xiaodong Wang 1 & Ting Li 1 & Shuang Ye 1 Received: 19 December 2019 / Revised: 8 April 2020 / Accepted: 5 May 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract Immune thrombocytopenia (ITP) is a common complication of connective tissue diseases (CTD). However, refractory and recurrent cases are frequent, who often need intensive immunotherapy. In the real world to compare the efficacy and safety of two common options, rituximab (RTX) and cyclosporine (CsA), in patients with refractory CTD-ITP, we conducted this retrospective study. Inpatients diagnosed with CTD-ITP who experienced treatment failure with initial prednisone or other immunosuppressants and who subsequently received either RTX or CsA between 2013 and 2018 were identified. All the patients were followed up for at least 6 months. Remission was defined as sustained platelet count ≥ 50 × 10^9/L, where ≥ 100 × 10^9/L was considered complete remission and 50–100 × 10^9/L was considered partial remission. Propensity score weighting analysis was performed to balance the confounders as indication. A total of 83 patients with CTD-ITP were identified, of whom 43 had systemic lupus erythematosus, 24 had undifferentiated CTD, and 16 had primary Sjogren syndrome. The RTX group (n = 53) had a much higher remission rate than the CsA group (n = 30) after 3 months and throughout the following 3 months (3 m, 86.8% vs 63.6%, p = 0.025; 6 m, 81.8% vs 53.5%, p = 0.011). Binary logistic regression analysis confirmed that treatment with RTX predicted better outcome (OR 4.09, 1.42 ~ 11.79), while age > 50 (OR 0.31, 0.11 ~ 0.93) was a risk factor. Furthermore, we reinforced the conclusions by propensity score weighting analysis (RTX OR 4.89, 1.64 ~ 14.58; age > 50 OR 0.31, 0.12 ~ 0.83). In our realworld retrospective study, for patients with refractory CTD-ITP, RTX was superior to CsA in terms of the durable remission rate.
Fangfang Sun and Jie Chen contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10067-020-05152-x) contains supplementary material, which is available to authorized users. * Shuang Ye [email protected]
Zhiwei Chen [email protected]
Fangfang Sun [email protected]
Liyang Gu [email protected]
Jie Chen [email protected]
Xiaodong Wang [email protected]
Wanlong Wu [email protected] Shikai Geng [email protected] WenWen Xu [email protected] Shuhui Sun [email protected]
Ting Li [email protected]
1
Department of Rheumatology, South Campus, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Jiang Yue Road 2000, Shanghai 201112, China
Clin Rheumatol
Key Points: • Refractory cases are common in patients with immune thrombocytopenia secondar
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