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
- Short-term Promacta® Therapy Effective
- Nplate® Changes Platelet Production in Surprising Ways
- Skin Problems Found in Some Promacta® Patients
- People with ITP Have More Surgical Complications
Hospitals, Insurance, and Medical Care
General Health and Medicine
ITP and Platelet Disorders Research and Treatments
Short-term Promacta® Therapy Effective
Sometimes people with ITP do not require constant therapy. In a trial of short-term administration of eltrombopag (Promacta®/Revolade®) participants were given three short-term courses of the drug. Of those that responded to the first cycle, 87% responded to the second and 71% responded to both the second and third cycle. Adverse events did not increase with subsequent cycles. The authors conclude that eltrombopag is likely to be safe and effective for those people with ITP who need only intermittent treatment.
Bussel JB. “Repeated short-term use of eltrombopag in patients with chronic immune thrombocytopenia (ITP).” Br J Haematol. 2013. v160, pp.538–546.
http://onlinelibrary.wiley.com/doi/10.1111/bjh.12169/abstract
Nplate® Changes Platelet Production in Surprising Ways
Scientists found that romiplostim (Nplate®) increased the number of megakaryocytes, the cells in the bone marrow that produce platelets, but decreased the ability of these megakaryocytes to spin off platelets. Increasing the dose of romiplostim increased these effects. Because this research was done in a test tube the scientists could explore some of the reactions in more detail. They found the platelet response correlated with the AKT protein involved in regulating cell survival.
Currao M et al. “High doses of romiplostim induce proliferation and reduce proplatelet formation by human megakaryocytes.” PLoS One. 2013;8(1):e54723. 2013 Jan 24.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3554640/
Skin Problems Found in Some Promacta® Patients
Doctors in Switzerland report three patients who had severe skin reactions to eltrombopag (Promacta®/Revolade®). In all three cases the skin problems cleared after eltrombopag was discontinued. Patient 1 was diagnosed with erythroderma, a scaly skin reaction. Patient 2 had exanthema, a wide-spread rash. Patient 3 had erythema, general redness. It is important to note that one of these patients had many other diseases and the other two had a history of allergic reactions.
Meyer SC et al. “Severe cutaneous toxicity related to Eltrombopag.” Br J Haematol. 2013. v160, pp.404–418.
http://onlinelibrary.wiley.com/doi/10.1111/bjh.12126/full
People with ITP Have More Surgical Complications
Surgical patients with ITP had more fatalities, more complications after surgery, longer hospital stays, a greater chance of going to the intensive care unit, and higher medical costs than those without ITP. This was particularly true if the person required red blood cell or platelet transfusions or was admitted during an emergency. To reach these conclusions researchers matched the medical records of people with ITP with those without the disease trying to isolate only those factors due to ITP.
Chang CC et al. “Adverse postoperative outcomes in surgical patients with immune thrombocytopenia.” Br J Surg. 2013 Jan 25.
http://www.ncbi.nlm.nih.gov/pubmed/23355086
Hospitals, Insurance, and Medical Care
Big Changes in US Healthcare Starting in 2013
The Affordable Care Act has many provisions. Some have been implemented; others will begin this year or later. For 2013: Insurance for small businesses and individuals must include essential health benefits in ten areas; Insurance, in most cases, must offer contraceptive coverage; States must plan for affordable insurance exchanges to be available January 1, 2014; Beginning January 1, 2014 insurers may not deny people coverage based on pre-existing conditions and must set insurance premiums evenly.
Haughton-Denniston P. “What’s New What's Next With the Affordable Care Act in 2013.” Dorland Health. January 7, 2013
http://www.dorlandhealth.com/case_management/trends/Whats-Next-With-the-Affordable-Care-Act-in-2013_2621.html
For additional information on the Affordable Care Act see:
http://www.healthcare.gov/
Coming Soon – More Information on Physician Payments
A new rule will require companies making drugs, biologics, devices, and supplies and receiving funds from federal healthcare programs (ex: Medicare, Medicaid) to report how much money they give to doctors and teaching hospitals. The Centers for Medicare and Medicaid Services (CMS) will begin collecting this data August 1, 2013 and will make it available on a public Web site by Sept. 30, 2014. According to Dr. Peter Budetti of the CMS, “Disclosure of these relationships allows patients to have more informed discussions with their doctors.”
“Affordable Care Act ‘Sunshine Rule’ Increases Transparency in Health Care.” CMS Press Release. February 1, 2013.
http://www.cms.gov/apps/media/press_releases.asp
General Health and Medicine
Steroids and Osteoporosis: Consider When First Prescribed
Corticosteroids (ex. prednisone) can cause osteoporosis with even a small dose. However, deciding when and how to treat bone loss involves many factors: availability and affordability of conventional treatments, likely implementation of lifestyle changes, age, and fracture risk. The World Health Organization has developed a tool to help determine the potential for fracture risk to aid the decision process (http://www.shef.ac.uk/FRAX/). Whatever the risk, it is important for the physician and the patient taking corticosteroids to discuss this complication early in the treatment cycle.
Deal CL, “Recent recommendations on steroid-induced osteoporosis: More targeted, but more complicated.” Cleveland Clinic Journal of Medicine. February 2013. v80:2. pp.117-125.
http://www.ccjm.org/content/80/2/117.full.pdf+html
Meditation Helps Quiet Inflammation
Quiet the mind, quiet the body. In a study comparing people who completed and practiced mindfulness-based stress reduction, a type of meditation, with those who didn’t, the meditators had an easier time handling stress and healed more quickly from induced inflammation. The author conclude: “These results suggest behavioral interventions designed to reduce emotional reactivity may be of therapeutic benefit in chronic inflammatory conditions.”
Rosenkranz MA et al. “A comparison of mindfulness-based stress reduction and an active control in modulation of neurogenic inflammation.” Brain, Behavior, and Immunity. January 2013. v 27.pp.174–184.
http://www.sciencedirect.com/science/article/pii/S0889159112004758
Note: ITP has been associated with increased inflammation.
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
