touchHAEMATOLOGY touchHAEMATOLOGY
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Tutorial

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Poll

Which of these potential approvals in ITP will have the most impact on your clinical practice?

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Sovleplenib
   
Rilzabrutinib
   
Mezagitamab
   
Other
   

Tutorial

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Poll

Which of the following best describes the role of splenectomy in ITP in your practice?

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Does not have a role
   
For patients who have received ā‰„3 prior treatments
   
For patients who have received ā‰¤2 prior treatments
   
Other
   

Tutorial

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Poll

In your patients with heavy menstrual bleeding, what proportion require hospitalization?

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>75%
   
50ā€“75%
   
25ā€“50%
   
<25%
   
 
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Thrombocytopenia, Rare Diseases, Autoimmune Blood Disorders CE/CME accredited

touchCONGRESS
Our faculty interpret key data from the congress, complimented by an expert panel discussing what has been presented. Close

Insights from EHA and ISTH 2024: How can we optimize care for patients with chronic ITP?

Learning Objectives

After watching this activity, participants should be better able to:

  • Recognize the impact of immune thrombocytopenia (ITP) on patients and their quality of life
  • Appraise the latest data for current chronic ITP treatments and how they may be applied to clinical practice to optimize patient outcomes
  • Evaluate the latest data for emerging chronic ITP therapies and their potential to impact patient outcomes
Overview

In this activity, an expert in ITP reviews key data on the impact of ITP on patients, as well as current and future treatments, presented at the European Hematology Association (EHA) and International Society on Thrombosis and Haemostasis (ISTH) 2024 congresses. Two additional leading experts discuss the potential implications of these data on clinical practice.

This activity was filmed following the EHA 2024 Hybrid Congress (Madrid, Spain; 13ā€“16 June) and ISTH 2024 (Bangkok, Thailand; 22ā€“26 June 2024).

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of haematologists, haemato-oncologists, nurses and nurse practitioners involved in the management of patients with ITP.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Dr Vickie McDonald discloses: Advisory board or panel fees from Amgen, Novartis and Sobi. Grants/research support from Grifols (relationship terminated).

Prof. Waleed Ghanima discloses: Advisory board or panel fees from Alpine, Amgen, Argenx, Cellphire, Grifols, HI-Bio, Hutchmed, Kedrion, Novartis, Pfizer, Principia Biopharma Inc, Sanofi, Sobi, Takeda and UCB. Grants/research support from Sanofi, Sobi and UCB. Speaker fees from Amgen, Bayer, Bristol Myers Squibb, Grifols, Novartis, Pfizer, Sanofi and Sobi.

Prof. James B Bussel discloses: Advisory board or panel fees from Argenx, Alpine-Vertex, Janssen, Rallybio, Sobi and UCB.

Content Reviewer

Danielle Walker, DNP, APRN, AGNP-C has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Contributors

Katrina Lester and Hannah Fisher have no financial interests/relationships or affiliations in relation to this activity.

Ian Seymour discloses: Independent contractor relationships with 90Ten Ltd., Axon Communications Ltd., Madano Healthcare, MadMicrobe Studios, Meditech Media and Open Health Group (relationships terminated).

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu.

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 1.0Ā AMA PRA Category 1 CreditTM.Ā  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) ā€“ European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTMĀ into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Advanced Practice Providers

Physician Assistants may claim a maximum of 1.0 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTMĀ from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTMĀ by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Nurses

USF Health is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Centerā€™s Commission on Accreditation.

A maximum of 1 contact hour may be earned by learners who successfully complete this continuing nursing education activity. USF Health, the accredited provider, acknowledges touchIME as the joint provider in the planning and execution of this CNE activity.

This activity is awarded 1 ANCC pharmacotherapeutic contact hour.

Date of original release: 5 September 2024. Date credits expire: 5 September 2025.

If you have any questions regarding credit please contact cpdsupport@usf.edu.

EBACĀ® Accreditation

touchIME is an EBACĀ® accredited provider since 2023.

This programme is accredited by the European Board for Accreditation of Continuing Education for Health Professionals (EBACĀ®) for 1.0 hours of effective education time.

The Accreditation Council for Continuing Medical Education (ACCMEĀ®), and the Royal College of Physicians and Surgeons of Canada hold an agreement on mutual recognition on substantive equivalency of accreditation systems with EBACĀ®.

Through an agreement between the European Board for Accreditation of Continuing Education for Health Professionals and the American Medical Association (AMA), physicians may convert EBACĀ® CE credits to AMA PRA Category 1 CreditsTM. Information on the process to convert EBACĀ® credit to AMA credit can be found on the AMA website. Other healthcare professionals may obtain from the AMA a certificate of having participated in an activity eligible for conversion of credit to AMA PRA Category 1 CreditTM.

Faculty Disclosure Statement / Conflict of Interest Policy

In compliance with EBACĀ® guidelines, all speakers/ chairpersons participating in this programme have disclosed or indicated potential conflicts of interest which might cause a bias in the presentations. The Organizing Committee/Course Director is responsible for ensuring that all potential conflicts of interest relevant to the event have been mitigated and declared to the audience prior to the CME activities

Requirements for Successful Completion

Certificates of Completion may be awarded upon successful completion of the post-test and evaluation form. If you have completed one hour or more of effective education through EBACĀ® accredited CE activities, please contact us at accreditation@touchime.org to receive your EBACĀ® CE credit certificate. EBACĀ® grants 1 CE credit for every hour of education completed.

Time to Complete: 1 hour

If you have any questions regarding the EBACĀ® credits, please contact accreditation@touchime.org

This activity is CE/CME accredited

To obtain the credit(s) from this activity, please complete this post-activity test.

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Course Modules

Topics covered in this activity

Thrombocytopenia / Rare Diseases / Autoimmune Blood Disorders
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Insights from EHA and ISTH 2024: How can we optimize care for patients with chronic ITP?
1.0 CE/CME credit

Question 1/5
Your female paediatric patient with ITP is attending a routine check-up with her parents. Her mother enquires about the potential future impact of ITP on her daughter as she transitions to adolescence. Based on recent findings from a retrospective chart review presented at ISTH 2024, what will you tell them?

HMB, heavy menstrual bleeding; ISTH, International Society on Thrombosis and Haemostasis; ITP, immune thrombocytopenia; QoL, quality of life.

Data from a retrospective chart review at a paediatric ITP centre in the USA presented at ISTH 2024 reported an incidence of HMB of 43.5% in female patients with ITP aged >10 years (n=85) and iron deficiency was reported in 78% of patients with ITP and HMB. The 37 patients with HMB required 42 visits to the hospital for the management of HMB.Ā 

Abbreviations

ISTH, International Society on Thrombosis and Haemostasis; HMB, heavy menstrual bleeding; ITP, immune thrombocytopenia.

Reference

Doshi BS, et al. Presented at: ISTH 2024, Bangkok, Thailand. 22ā€“26 June 2024. Poster PB0694.

Question 2/5
Based on data presented at EHA 2024, what proportion of patients with ITP experienced a sustained response for >4 years after TPO-RA discontinuation?

EHA, European Hematology Association; ITP, immune thrombocytopenia; TPO-RA, thrombopoietin receptor agonist.

Data presented at EHA 2024 from the French, prospective interventional STOPAGO study (NCT03119974) of adults with persistent or chronic primary ITP who discontinued TPO-RAs showed that 52.1% and 47.9% of patients experienced a sustained response off treatment for 1 year and >4 years, respectively. A sustained response off treatment was defined as a platelet count ā‰„30 x 109/L and no bleeding without ITP-specific medications.

Abbreviations

EHA, European Hematology Association; ITP, immune thrombocytopenia; TPO-RA, thrombopoietin receptor agonist.

Reference

Cottu A, et al. Presented at: EHA2024 Hybrid Congress, Madrid, Spain. 13ā€“16 June 2024. Poster P1628.

Question 3/5
Your patient with chronic refractory ITP has previously received 3 lines of treatment and is now starting treatment with fostamatinib. Taking into consideration recent data presented at EHA 2024, and the latest understanding of the disease, what would you do next to best manage this patient?

EHA, European Hematology Association; ITP, immune thrombocytopenia.

A retrospective, multicentre, Italian observational study of heavily pre-treated patients with chronic ITP who received at least one dose of fostamatinib outside of clinical trials between 1 October 2021 and 1 April 2023 (N=91) was presented at EHA 2024. It reported hypertension as the second most common side effect (n=8), which led to fostamatinib discontinuation in one patient.1

Patients receiving fostamatinib should have their blood pressure monitored every 2 weeks until stable, then monthly. Antihypertensive treatment should be used as necessary to ensure maintenance of blood pressure control.2,3

Abbreviations

EHA, European Hematology Association; ITP, immune thrombocytopenia.

References

  1. Zaja F, et al. Presented at: EHA2024 Hybrid Congress, Madrid, Spain. 13ā€“16 June 2024. Poster P2232.
  2. FDA. Fostamatinib PI. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2018/209299lbl.pdf (accessed 27 August 2024)
  3. EMA. Fostamatinib SmPC. Available at: www.medicines.org.uk/emc/product/11479/smpc/print (accessed 27 August 2024)
Question 4/5
When discussing data reported at EHA 2024 with colleagues, how would you describe the risk of GI toxicities associated with the SYK inhibitor sovleplenib?

AE, adverse event; EHA, European Hematology Association; GI, gastrointestinal; SYK, spleen tyrosine kinase.

ESLIM-01 is a randomized, double-blind, placebo-controlled, phase III trial (NCT05029635) to evaluate the efficacy and safety of the SYK inhibitor sovleplenib in patients with primary ITP in China. Data reported at EHA 2024 (data cut-off 14 July 2023) demonstrated a low rate of GI toxicities associated with sovleplenib (incidence of diarrhoea, vomiting and nausea all 1.6%).1Ā 

An open-label extension study (NCT02077192) investigating the efficacy and safety of the SYK inhibitor fostamatinib in patients with primary ITP reported diarrhoea as the most comment TEAE, occurring in 35% of patients; nausea occurred in 19% of patients.2Ā 

Abbreviations

AE, adverse event; EHA, European Hematology Association; GI, gastrointestinal; ITP, immune thrombocytopenia; SYK, spleen tyrosine kinase; TEAE, treatment-emergent AE.

References

  1. Yang R, et al. Presented at: EHA2024 Hybrid Congress, Madrid, Spain. 13ā€“16 June 2024. Oral presentation S316.
  2. Bussel JB, et al. Am J Hematol. 2019;94:546ā€“53.
Question 5/5
You are discussing potential enrolment in the LUNA3 clinical trial with your patient with chronic ITP who has previously received one line of therapy. They enquire about expected outcomes associated with rilzabrutinib. Based on interim data from the LUNA2 trial reported at ISTH 2024, what would you tell them?

ISTH, International Society on Thrombosis and Haemostasis; ITP, immune thrombocytopenia; TPO-RA, thrombopoietin receptor agonist.

Pooled analysis of parts A and B of the phase II LUNA2 trial (NCT03395210) investigating the efficacy and safety of the Bruton tyrosine kinase inhibitor rilzabrutinib in patients with relapsed/refractory ITP demonstrated higher clinical responses in patients with fewer prior and earlier lines of ITP treatment (86% vs 37% for second-line vs at least third-line; 71% vs 33% for <4 and ā‰„4 unique prior treatments; pā‰¤0.05 for both).

Abbreviation

ITP, immune thrombocytopenia.

Reference

Kuter D, et al. Presented at: ISTH 2024, Bangkok, Thailand. 22ā€“26 June 2024. Oral presentation OC 13.3.

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