Rate of bleeding-related episodes in elderly patients with primary immune thrombocytopenia: a retrospective cohort study

Abstract

Objective: Immune thrombocytopenia (ITP) is characterized by low platelet counts and a tendency toward increased bleeding and bruising. We aimed to describe bleeding frequency and use of rescue ITP therapy to treat or prevent bleeding in elderly ITP patients in a real-world setting.

Methods: Using Medicare 20% sample data, 2007–2012, we identified elderly (ages ≥67 years) Medicare fee-for-service enrollees diagnosed with primary ITP between 1 January 2009 and 30 September 2012. Bleeding-related episodes (BREs) were defined as ≥1 bleeding event or use of ITP therapies commonly considered for rescue or emergency therapy. BRE rates were examined for the cohort overall, by time since ITP onset, and by splenectomy status. Patients were followed from ITP onset until the earliest of death, disenrollment from fee-for-service coverage, or 31 December 2012.

Results: We identified 3007 elderly patients diagnosed with primary ITP (mean [SD] age: 79.6 [7.5] years; 55% female); 2178 (72%) experienced at least one BRE (8867 BREs); 92 (3%) underwent splenectomy. Nearly half of BREs were defined by rescue therapy use alone. The overall rate was 1.72 BREs per patient-year (95% CI; 1.68–1.75); rates were higher during the first 3 months after ITP onset and after splenectomy.

Conclusion: Elderly ITP patients experienced about two BREs per patient-year after ITP onset. Most patients experienced at least one BRE. These real-world results demonstrate the importance of examining both bleeding and use of rescue or emergency ITP therapy in the assessment of disease burden in elderly patients with ITP.

Keywords:

• Bleeding-related episodes
• immune thrombocytopenia
• Medicare

Transparency

Declaration of funding

This work was supported by Amgen Inc., Thousand Oaks, CA, USA. The contract provides for the Minneapolis Medical Research Foundation authors to have final determination of manuscript content.

Author contributions: All authors were involved in the conception and design of the research and in interpretation of the data. J.T.M. and S.L. performed the statistical analysis. S.L. and J.T.M. wrote the first draft of the manuscript and made edits recommended by other authors; K.C., J.S.W. and I.A. made comments and suggestions for important intellectual content. All authors gave final approval of the version to be published. All authors agree to be accountable for all aspects of the work. All authors confirm that no off-label use of therapies was discussed or promoted at any instance throughout the manuscript.

Declaration of financial/other relationships

S.L. and J.T.M. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article. K.C. has disclosed that she is an employee of Amgen. I.A. has disclosed that she is a consultant for Amgen and Genentech and an advisory board member for Incyte and Novartis. J.S.W. has disclosed that he receives research support from Amgen and is a consultant and advisory board member for Amgen; he has also consulted for Novartis.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

The authors thank Chronic Disease Research Group colleagues Anne Shaw for manuscript preparation, and Nan Booth MSW MPH ESL for manuscript editing.