Kashiwagi Hirokazu, Miura Isao, Terasawa Naohiko, Iwayama Ken-Ichi, Furukawa Yuka, Kanenishi Makoto
Department of Hematology and Oncology, Osaka University Graduate School of Medicine, Postal Address: 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Osaka Red Cross Blood Center, Osaka, Japan.
Int J Hematol. 2025 Mar;121(3):363-377. doi: 10.1007/s12185-024-03897-8. Epub 2024 Dec 12.
Recent trends in the treatment of primary immune thrombocytopenia (ITP) were investigated using a claims database that included data from 16,161 Japanese patients with ITP collected from April 2014 to August 2022. Of the 4144 adult patients analyzed, 1276 received corticosteroids. The mean and median durations of corticosteroid use were 115.31 and 41 days, respectively. The time to withdrawal of corticosteroids was significantly shorter in 2020 to 2021 than in 2015 to 2019. Additionally, the number of prescriptions for thrombopoietin receptor agonists increased from 2015 to 2021 and exceeded that of corticosteroids in 2021. While these results suggest a trend towards reduction in corticosteroid use in real-world settings in Japan, 12.00% of patients received a corticosteroid dose of ≥ 10 mg/day at Week 12. Furthermore, 23.05% of patients continued to receive corticosteroids at Week 24, indicating that some patients were still receiving long-term corticosteroid treatment. The risk of adverse outcomes was significantly associated with corticosteroid use. In conclusion, new treatment options may lead to more sophisticated ITP management with less corticosteroid use, although further research and reconsideration of clinical practice guidelines is needed.
利用一个索赔数据库对原发性免疫性血小板减少症（ITP）的近期治疗趋势进行了调查，该数据库包含了2014年4月至2022年8月收集的16,161例日本ITP患者的数据。在分析的4144例成年患者中，1276例接受了皮质类固醇治疗。皮质类固醇的平均使用时长和中位使用时长分别为115.31天和41天。2020年至2021年停用皮质类固醇的时间明显短于2015年至2019年。此外，促血小板生成素受体激动剂的处方数量从2015年到2021年有所增加，并在2021年超过了皮质类固醇。虽然这些结果表明在日本的实际临床中皮质类固醇的使用有减少的趋势，但12.00%的患者在第12周时接受的皮质类固醇剂量≥10mg/天。此外，23.05%的患者在第24周时仍在接受皮质类固醇治疗，这表明一些患者仍在接受长期皮质类固醇治疗。不良结局的风险与皮质类固醇的使用显著相关。总之，新的治疗选择可能会使ITP的管理更加精细，同时减少皮质类固醇的使用，不过仍需要进一步的研究和对临床实践指南进行重新审视。
