Yassin Mohamed A, AlRasheed Muna, Al-Eisa Taghreed, Alhashim Noura, Alsayegh Fiasal, Abouzeid Tarek E, Abd El Fattah Mohamed, Alfili Maryam, Shalaby Neveen, Alotaibi Abdullah, Aljuwaisri Nourah, Almasbahi Anwar, Saleeb Rii, Abdelaziz Hend, Alshurafa Awni, Ismail Omar, Ghasoub Rola
Department of Hematology and Bone Marrow Transplant, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar.
College of Medicine, Qatar University, Doha, Qatar.
Front Nutr. 2025 Feb 26;12:1434484. doi: 10.3389/fnut.2025.1434484. eCollection 2025.
In recent years, significant advances have been made in the treatment of immune thrombocytopenia (ITP) with the development of thrombopoietin receptor agonists (TPO-RAs). TPO-RAs are often used following the failure of prior therapies or when bleeding episodes persist despite glucocorticoid use. In Muslim countries, where religious observance includes 16/8 intermittent fasting, the timing of medication administration may be affected. This study is the first to evaluate the impact of Ramadan fasting on patients receiving different TPO-RAs.
A multicenter mixed-design study was performed in which Muslim patients who fasted during Ramadan while receiving TPO-RAs were interviewed between 2015 and 2023. Patient responses before, during, and after Ramadan were evaluated retrospectively. The bleeding tendency was assessed as (1) no bleeding, (2) minor cutaneous/mucosal bleeding, or (3) severe bleeding that involves major organs.
The present study included 100 patients from three Muslim countries, including Qatar, Kuwait, and Saudi Arabia, across four tertiary centers. A complete response was observed in 63% of patients on ROM, 46% on ELT and 37% on AVA. For AVA, the mean platelet (PLT) count before Ramadan was estimated at [146.11 ± 111.76], while during Ramadan, it dropped to [131.7 ± 107.6]. For patients on ELT, the mean PLT count before Ramadan was estimated at [120.02 ± 59.7], while during Ramadan, it dropped to [100.8 ± 68.16] ( = 0.016). For patients on ROM, the mean platelet count before Ramadan was estimated at [122.68 ± 80.57], while during Ramadan, it was [130.94 ± 84.96]. Only 3% (3 patients on ELT) experienced bleeding episodes.
This study supports the feasibility of Ramadan fasting for ITP patients receiving TPO-RAs. Further studies with a larger sample size are recommended to investigate the impact of other types of fasting on the efficacy and safety of TPO-RAs.
近年来，随着血小板生成素受体激动剂（TPO-RAs）的发展，免疫性血小板减少症（ITP）的治疗取得了重大进展。TPO-RAs常用于先前治疗失败后或尽管使用糖皮质激素但出血事件仍持续存在的情况。在宗教仪式包括16/8间歇性禁食的穆斯林国家，药物给药时间可能会受到影响。本研究是首个评估斋月禁食对接受不同TPO-RAs治疗的患者影响的研究。
进行了一项多中心混合设计研究，对2015年至2023年期间在斋月期间禁食同时接受TPO-RAs治疗的穆斯林患者进行了访谈。回顾性评估患者在斋月前、斋月期间和斋月后的反应。出血倾向评估为：（1）无出血，（2）轻微皮肤/粘膜出血，或（3）涉及主要器官的严重出血。
本研究纳入了来自卡塔尔、科威特和沙特阿拉伯三个穆斯林国家四个三级中心的100名患者。接受罗米司亭（ROM）治疗的患者中63%观察到完全缓解，接受艾曲泊帕乙醇胺（ELT）治疗的患者中46%，接受阿伐曲泊帕（AVA）治疗的患者中37%。对于AVA，斋月前平均血小板（PLT）计数估计为[146.11±111.76]，而在斋月期间降至[131.7±107.6]。对于接受ELT治疗的患者，斋月前平均PLT计数估计为[120.02±59.7]，而在斋月期间降至[100.8±68.16]（P = 0.016）。对于接受ROM治疗的患者，斋月前平均血小板计数估计为[122.68±80.57]，而在斋月期间为[130.94±84.96]。只有3%（3名接受ELT治疗的患者）经历了出血事件。
本研究支持斋月禁食对接受TPO-RAs治疗的ITP患者的可行性。建议进行更大样本量的进一步研究，以调查其他类型禁食对TPO-RAs疗效和安全性的影响。
