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
- Switching TPO Agents May Improve Outcome
- Eltrombopag Gets the OK in the UK
- Intriguing New Treatment from China
- Rituxan Plus Dexamethasone: An Effective Combo
Hospitals, Insurance, and Medical Care
General Health and Medicine
ITP and Platelet Disorders Research and Treatments
SWITCHING TPO AGENTS MAY IMPROVE OUTCOME
Eltrombopag (Promacta®/Revolade®) and romiplostim (Nplate®) are similar to naturally occurring thrombopoietin (TPO) in that they stimulate the bone marrow to produce more platelets. While they are very effective, they don't work for everyone. Two patients were featured in a report demonstrating that switching from one agent to another may be beneficial. In one case the patient was given eltrombopag, then switched to romiplostim. In another patient, the switch was from romiplostim to eltrombopag. In both cases the patients improved with the second TPO option. Romiplostim and eltrombopag attach to a different position in the thrombopoietin receptor and that, along with subtle differences in the patients' genes, may explain these results.
Polverelli N et al. "Absence of bi-directional cross-resistance of thrombopoietin receptor agonists in chronic refractory immune thrombocytopenia: possible role of MPL polymorphisms." Br J Haematol. Dec. 29, 2012.
http://onlinelibrary.wiley.com/doi/10.1111/bjh.12186/full
ELTROMBOPAG GETS THE OK IN THE UK
The National Institute for Health and Clinical Excellence (NICE) in the UK issued draft guidance approving the use of eltrombopag (Revolade®) for qualified UK patients. The treatment is recommended for those people who have had a splenectomy and failed corticosteroids and IVIg or as a second- line treatment in cases where a splenectomy could cause problems. The final guidance is scheduled for May, 2013, and is dependent upon the manufacturer supplying the drug at a discount. Romiplostim was approved by NICE in 2011 with similar terms.
NICE Press Release. "NICE says yes in draft guidance to eltrombopag for the treatment of chronic immune (idiopathic) thrombocytopenic purpura." Dec. 18, 2012.
http://www.nice.org.uk/newsroom/pressreleases/NICESaysYesInDraftGuidanceToEltrombopagForTheTreatmentOfChronicImmuneIdiopathicThrombocytopenicPurpura.jsp
INTRIGUING NEW TREATMENT FROM CHINA
Painengda® is a new treatment being tested in China for the treatment of ITP as well as diseases with low amounts of white and red blood cells. The drug, a patented compound isolated from ginseng (a plant used to treat various ailments for centuries) stimulates the bone marrow to produce more blood cells and regulates the immune system. Based on successful animal testing, it was approved for clinical trials in 2010. Production of the compound is moving forward.
Note: Ginseng can interfere with the ability of blood to clot. However Painengda contains just one of the many compounds in ginseng and has different properties.
Gao RL,Chong BH. "Research and development of the effective components of panaxdiol saponin as new chinese patent medicine for treating hemocytopenia." Chin J Integr Med. 2012 Dec;18(12):897-902.
http://www.ncbi.nlm.nih.gov/pubmed/23238997
RITUXAN PLUS DEXAMETHASONE: AN EFFECTIVE COMBO
Dexamethasone (a corticosteroid similar to prednisone) and rituximab (Rituxan®) are both used to treat ITP soon after diagnosis. Perhaps a combination of the two would lead to a better recovery rate. To investigate that possibility researchers randomized 133 newly diagnosed patients into two groups, one group taking dexamethasone alone and the other trying the duo. The combo group did have a better response rate with 58% achieving a platelet count greater than 50,000/uL at six months versus 37% for the dexamethasone group. The combo group also had a longer-lasting response and more adverse events.
Gudbrandsdottir S, "Rituximab and dexamethasone vs dexamethasone monotherapy in newly diagnosed patients with primary immune thrombocytopenia." Blood. 2013 Jan 4.
http://www.ncbi.nlm.nih.gov/pubmed/23293082
Hospitals, Insurance, and Medical Care
HEALTH INSURANCE PREMIUMS: BIG INCREASE FOR MANY
Insurance companies in the US are sometimes asking for and getting double-digit rate increases (some more than 20%) in healthcare premiums, mostly for small businesses and individuals with their own health insurance. The rate hikes for employee-based plans are about 4%. Some states regulate insurance rates and others so not which leads to a big difference in the rates by state. Medical costs are expected to increase an average of about 7.5% next year.
Between 2003 and 2011 premiums for employee-based health insurance plans increased 62%, employee contributions increased 74%, and the cost of deductibles has risen 177%, indicating that everyone is paying more for insurance and getting fewer protective benefits.
Abelson R. "Health Insurers Raise Some Rates by Double Digits." New York Times. Jan. 5, 2013.
http://www.nytimes.com/2013/01/06/business/despite-new-health-law-some-see-sharp-rise-in-premiums.html
Schoen C. "State Trends in Premiums and Deductibles, 2003–2011: Eroding Protection and Rising Costs Underscore Need for Action." The Commonweath Fund Issue Brief. Dec. 12, 2012 | Volume 31.
http://www.commonwealthfund.org/Publications/Issue-Briefs/2012/Dec/State-Trends-in-Premiums-and-Deductibles.aspx (includes state-by-state variations).
HALF OF ALL HEALTHCARE SPENDING MAY BE WASTEFUL
Of the $2.2 trillion spent on healthcare in the United States, $1.2 trillion is wasted, according to a Price Waterhouse Coopers report. The wasteful practices fall into three categories: behavioral (where lifestyle changes can prevent or help the problem); clinical (overuse, misuse, underuse, missed opportunities or errors in medical care); and operational (administrative and other business costs that do not benefit the patient.)
"The price of excess: Identifying waste in healthcare spending." Price Waterhouse Cooper (complete report - free .pdf)
http://www.pwc.com/us/en/healthcare/publications/the-price-of-excess.jhtml
General Health and Medicine
AMERICANS SICKER THAN MANY OTHERS
Americans die sooner and have more illnesses and accidents than those in 16 other affluent countries according to a report by the National Research Council and the Institute of Medicine. This was true for everyone including those with higher incomes, a college education, and health insurance. The average life expectancy for men, 75.6 years, was the lowest of all countries included in the report. The average life expectancy for women, 80.8 years, was the second lowest. A national conversation on the importance of public health could help mitigate the many factors that contribute to these disparities and close the wellness gap.
Radnofsky L. "U.S. Lags Peers in Life Expectancy." The Wall Street Journal. Jan. 10, 2013 page A2.
U.S. Health in International Perspective: Shorter Lives, Poorer Health. National Academies Press. 2013. (complete report - free .pdf)
http://www.nap.edu/catalog.php?record_id=13497
Note: PDSA encourages everyone to adopt healthy lifestyle practices.
See http://www.pdsa.org/products-a-publications/diet-a-lifestyle-info.html
STAND UP – LIVE LONGER
Americans could theoretically gain up to two years in life expectancy if they reduced their sitting time to less than three hours per day, according to an analysis of available data. If TV watching was reduced to less than 2 hours per day, that act alone could increase life expectancy by 1.38 years. These research findings suggest that a sedentary life is a comparable health risk to smoking and obesity.
Katzmarzyk PT, Lee I-M. "Sedentary behaviour and life expectancy in the USA: a cause-deleted life table analysis." 2012. British Medical Journal Open.
http://bmjopen.bmj.com/content/2/4/e000828.full.pdf+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
