DP063 | EARLY USE OF THROMBOPIETIN RECEPTOR AGONISTS (TPO-RAS) IN CLINICAL PRACTICE: RESULTS FROM AN ITALIAN SURVEY ON BEHALF OF THE GIMEMA WORKING GROUP ANEMIA AND THROMBOCYTOPENIA

We have here performed a nationwide survey specifically focused on the early administration of Thrombopoietin Receptor Agonists (TPO-RAs), in the current Italian clinical practice. The survey was performed to evaluate opinions and behaviours of haematologists expert in primary immune thrombocytopenia (p-ITP) care in ItalyThe current survey was structured as a 13- item questionnaire ,with an accurate definition on the clarity of questions. Survey items were structured as close-ended or multiple choice-style questions. The main topics of the proposed questions on TPO-RAs referred to: timing and schedule of administration, ideal candidate profile, perceived risk factors for their early administration, main factors in favour or against their early use. Overall, 41 participants answered the survey , the whole cohort of patients affected by pITP followed by the Centers partecipating to the survey, was composed by 4588 subjects: 20,69% affected by newly diagnosed ITP, 19,53% with persistent ITP and 59,78% with chronic ITP .Main results show that the choice of the ideal candidate to early treatment with TPO-RAs is mainly defined on the basis of comorbidities including cardiovascular risk factors, corticosteroids-related toxicities, while it seems unrelated to age. The most relevant factors againts an early administration of TPO-RAs are a diagnostic uncertainty, the risks of over-exposure, comorbidities. A front line treatment with TPO-RAs can be taken into account in cases of severe bleeding unresponsive to steroids and immunoglobulins or for a clear need of a “steroids sparing” approach. Survey results show that an early use of TPO-RAs is frequently adopted in the common clinical practice, also immediately after a first line therapy; the main driver for the early use is always the clinical condition, in particular an absent or unsatisfactory response . The current results have confirmed what was already preceived among Italian hematologists during the previous evaluation performed by our group, in particular to consider desirable an earlier and much more flexible administration of TPO-RA. Available data suggest that, even if TPO-RAs show overlap efficacy during the different phases (newly diagnosed, persistent or chronic ) of ITP, the early adminsitration of eltrobopag and romiplostin may be associated with improved clinical outcomes ) , particularly referred to the sustained response off therapy