Platelet E-News: May 24th, 2012

This e-newsletter is a monthly publication of the Platelet Disorder Support Association. The information in this newsletter is for educational purposes only. For advice on your unique medical condition, please consult a health care professional.

Contents:

ITP and Platelet Disorders Research and Treatments

Hospitals, Insurance, and Medical Care

General Health and Medicine

--------------------------------------------------------------------------------------------------------

ITP and Platelet Disorders Research and Treatments

 

CAN IGA AND IGM ANTIBODY LEVELS HELP PREDICT TREATMENT FAILURE?

 An analysis of the antibody levels of nearly 500 ITP patients demonstrated two intriguing patterns. Those with higher levels of IgA (immunoglobulin A) than most people did not respond as well to the usual first-line treatments of ITP (steroids, IVIg, and anti-D) and had an increased risk of bleeding. People with a lower level of IgM (immunoglobulin M) than the standard also didn't respond as well to the usual first-line treatments and, in addition, had a decreased response to splenectomy. The authors conclude: "These observations suggest that immune dysregulation as represented by elevations in IgA or decreased levels of IgM are associated with ITP that is more resistant to treatment."

Note: IgA antibodies are found in mucus secretions of the nose, mouth, digestive tract, and other areas of the body to protect against outside pathogens. IgM antibodies, the first responders to infection, are found mainly in the blood and lymph fluid.

Arnason JE et al. "Abnormalities in IgA and IgM are associated with treatment-resistant ITP." Blood. 2012 Apr 6. http://www.ncbi.nlm.nih.gov/pubmed/22490683

FIVE YEAR RITUXIMAB SUCCESS REVEALED

The five-year response rate for rituximab (Rituxan®) was 21% in adults and 26% in children according to a research study analyzing the long-term success of 75 ITP patients who had a one-year response to the treatment. Both adults and children had about the same initial response rate to rituximab, 57%. Children who had a two-year response to rituximab generally continued to do well, whereas adults were more prone to relapse after that time period. Splenectomy status had no bearing on the response rate. Dr. James Bussel, a study author, suggests his next step is to combine rituximab with dexamethasone, a steroid, to try to help boost the response rate.

Note: Rituximab kills B-cells, the white blood cells responsible for creating the antibodies that attach to the platelets of people with ITP. For more information on the treatment see http://www.pdsa.org/treatments/conventional/b-cell-depletion.html

Press Release "Rituximab Promotes Long-Term Response for Patients with Immune Destruction of Platelets." American Society of Hematology. May 7, 2012. http://www.hematology.org/News/2012/8318.aspx

Patel VL et al. "Outcome at 5 years following response to rituximab therapy in children and adults with immune thrombocytopenia (ITP)." Blood. 2012 May 7. http://www.ncbi.nlm.nih.gov/pubmed/22566601

TPO TREATMENTS: ARE THE BENEFITS WORTH THE COSTS?

The cost-effectiveness of the thrombopoietin mimetic treatments, eltrombopag (Promacta®/Revolade®) and romiplostim (Nplate®) come under financial scrutiny because of their cost and potentially long-term treatment duration. In one research study, the authors conclude: "highly effective and well-tolerated medications such as romiplostim may reduce the healthcare resource utilization associated with ITP while improving patients' HRQoL [health-related quality of life]" To reach this conclusion the study took into account the cost of the adverse effects of current treatments as well as research showing that many people with ITP endure various physical and emotional hardships from the disease that may be relieved with an effective treatment.

On the other hand, researches in the UK, in a report for National Institute for Health and Clinical Excellence, concluded that the cost of eltrombopag did not meet their financial standards of an incremental cost-effectiveness ratio below £ 30,000 per quality-adjusted life-year, a measure of how well and how long a person will live given a treatment. This study compared the use of eltrombopag to a watch-and-rescue treatment scenario. Bleeding was the only adverse event considered.

Deuson R et al. "The Burden of Immune Thrombocytopenia in Adults: Evaluation of the Thrombopoietin Receptor Agonist Romiplostim." J Med Econ. 2012 Apr 26. http://www.ncbi.nlm.nih.gov/pubmed/22533524

Boyers D et al. "Eltrombopag for the Treatment of Chronic Immune or Idiopathic Thrombocytopenic Purpura: A NICE Single Technology Appraisal." Pharmacoeconomics. 2012 Jun 1;30(6):483-95. http://www.ncbi.nlm.nih.gov/pubmed/22480381

For more information on romiplostim, eltrombopag, and other thrombopoietin mimetics used to treat ITP see http://www.pdsa.org/treatments/conventional/platelet-growth-factors.html

TAWA-TAWA HERB: NEW APPROACH TO RAISING PLATELETS

Herbal remedies have been used in several countries to raise the platelets of people with dengue fever, a disease characterized by a high body temperature and low platelets. Scientists in the Philippines are closely examining the platelet-raising potential of the tawa-tawa plant (Euphorbia hirta) as well as its anti-viral and anti-inflammatory properties. They want to find specific compounds in the plant responsible for these actions and, if their testing is successful, use these compounds to develop new drugs. More than a quarter of the active ingredients for new drugs between 1981 and 2002 were isolated from natural products.

Marchadesch B. "Local Tawa-tawa herbs may cure tuberculosis, dengue." GMA News. April 12, 2012. http://www.gmanetwork.com/news/story/254965/scitech/science/local-tawa-tawa-herbs-may-cure-tuberculosis-dengue

For more information on herbal remedies for ITP see http://www.pdsa.org/treatments/complementary/herbal-remedies.html

 

Hospitals, Insurance, and Medical Care

FEDERAL FOCUS ON OBESITY EXPANDING

Obesity rates have more than doubled since 1980 and, if the trend continues, about 42% of the people in the US will be obese by 2030, according to a 462-page report from the Institute of Medicine. Instead of putting all the responsibility on the obese person to eat less and exercise more, the report suggests attacking the problem from multiple social and environmental angles. These include increasing the availability of healthy food, reducing the consumption of sugar-sweetened beverages, and making it easier to walk or bike to destinations. Schools, businesses, and the government would need to cooperate to solve the problem. Obesity is responsible for $190 billion in healthcare costs, one-fifth of healthcare spending, not including increased insurance premiums and lost productivity. To help promote the message the National Institutes of Health, the Institute of Medicine, and the Centers for Disease Control and Prevention worked with HBO to produce a film and documentary series on the subject, The Weight of the Nation, available free on HBO.com (http://theweightofthenation.hbo.com/)

Begley S. "Obesity Fight Must Shift From Personal Blame: U.S. Panel." Reuters. May 8, 2012. http://www.reuters.com/article/2012/05/08/us-usa-health-obesity-idUSBRE8470LC20120508

Glickman D et al. "Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation." National Academies Press. 2012. https://download.nap.edu/catalog.php?record_id=13275

Press Release. "NIH research featured in HBO documentary series on obesity." National Heart Lung and Blood Institute. May 1, 2012. http://www.nhlbi.nih.gov/news/press-releases/2012/nih-research-featured-in-hbo-documentary-series-on-obesity.html

HEALTHCARE SPENDING FLATTENS

After years of consuming an ever-increasing percent of total spending, healthcare costs have stabilized at 17.9% of the gross national product. In 2009 and 2010 healthcare spending grew 4%, the smallest increase in more than 50 years. Some of the reduced increase can be attributed to the recession. But other factors such as the rise in the number of high-deductible insurance plans, greater use of generic drugs, and an emphasis on accountable care (payment for quality, not quantity) may signal a more permanent downward shift. A one percent drop in the growth of Medicare spending per year could reduce the projected long-term federal deficit by more than 30%.

Lowrey A. "In Hopeful Sign, Health Spending Is Flattening Out." New York Times. April 28, 2012. http://www.nytimes.com/2012/04/29/health/policy/in-hopeful-sign-health-spending-is-flattening-out.html

 

General Health and Medicine

X-RAYS IN CHILDREN: CAUTION ADVISED

Frequent dental x-rays were linked to twice as many cases of intracranial meningiomas, a type of brain tumor, in a study comparing the dental history of 1433 people with matched controls. Those who had x-rays yearly or more frequently as children were most susceptible. People who had x-rays using panorex films before age ten had an almost five-fold greater risk of developing a meningioma than those who didn't have dental x-rays.

Children are more susceptible to the adverse effects, including the possibility of cancer, of all types of x-rays including CT scans and procedures using radioactive dye. When considering an x-ray, it is important to think about the medical necessity and to be sure the dose is adjusted for the age of the child. The FDA recently updated their Web page on pediatric x-ray imaging, providing information for parents and physicians on radiation procedures for children. See: http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/ucm298899.htm

Claus EB. "Dental x-rays and risk of meningioma." Cancer. 2012 Apr 10. http://www.ncbi.nlm.nih.gov/pubmed/22492363

IS AMERICAN IDOL GOOD FOR YOUR HEALTH?

Listening to music can calm your anxiety, reduce stress, soothe pain, and improve hearing, heart health, and stroke recovery. But, it has to be music you like, the more melodic and joyful the better. Playing music, not just listening, can help as well. Music training in children and adults helps memory and brings more mental focus. Maybe Bob Seger was right when he wrote: "Still like that old time rock and roll/The kinda music just soothes the soul."

For more information on the benefits of music for people with ITP see http://www.pdsa.org/treatments/complementary/energy-therapy.html

Chan AL. "Music And Health: 11 Ways Playing And Listening To Music Help Both Body And Mind." Huffington Post. April 11, 2012. http://www.huffingtonpost.com/2012/04/09/music-and-health-11-ways-body-mind_n_1413241.html

 

--------------------------------------------------------------------------------------------------------

This e-newsletter is published by the Platelet Disorder Support Association, 133 Rollins Avenue, Suite 5, Rockville, MD 20852, phone 1-87-Platelet, fax: 301-770-6638, web: http://www.pdsa.org, e-mail: pdsa@pdsa.org

back to top

BBB Cleveland logo GuideStar Seal NORD Member Badge 2018THSNA logo