Platelet E-News: September 25, 2013

ITP and Platelet Disorders Research and Treatments

Hospitals, Insurance, and Medical Care

General Health and Medicine

 

ITP and Platelet Disorders Research and Treatments

Prednisone Causes Adrenal Problems

Long-term corticosteroids, like prednisone, significantly diminished adrenal function in almost half of the 60 patients tested in a recent study. After the prednisone was stopped, the adrenal function in the test population returned to normal, when it was measured some months later. People who took the prednisone for a longer time, at a higher cumulative dose, had more adrenal problems.

Sacre et al. “Pituitary-Adrenal Function After Prolonged Glucocorticoid Therapy for Systemic Inflammatory Disorders: An Observational Study.” JCEM. August 2013.
http://jcem.endojournals.org/content/98/8/3199.abstract

 

Rigel Testing New Treatment for ITP

Rigel Pharmaceuticals announced that it is planning a Phase III clinical study of fostamatinib in ITP, pending discussions with regulatory agencies. Fostamatinib is a pill that stops macrophages, a kind of white blood cell, from destroying antibody-coated platelets. The Phase III trial would enroll about 150 patients and be completed in 2015. In a Phase II trial of the drug, 75% of the people responded. The most frequent side effect was nausea. You can watch a YouTube clip that illustrates how the drug works at:
http://www.youtube.com/watch?v=ov2JUHDpt58.

“Rigel To Focus On ITP, DLE And Dry Eye:Strategy Provides Multiple Paths to Phase 3/NDA in Next 2-3 Years.” Digital Journal. Sept. 5, 2013
http://www.digitaljournal.com/pr/1451169#ixzz2eoMbP4Dr

“Fostamatinib (R788) – ITP.” Rigel Pharmaceuticals.
http://www.rigel.com/rigel/ITP

 

No Treatment, Better Quality-of-Life for ChildrenChild Playing

The quality-of-life of children with ITP who were treated for the disease was worse than children with ITP who were not treated, according to a survey of 217 parents of children in six countries. To reach this conclusion the researchers examined factors that could account for the variation. They found no significant differences in the initial platelet count, symptoms, or age of the children in the treatment and non-treatment groups that would explain the results. The largest decrease in quality-of-life was for newly diagnosed children treated with prednisone.

Grainger JD,et al. “Quality of life in immune thrombocytopenia following treatment.” Arch Dis Child. 2013 Aug 16.
http://www.ncbi.nlm.nih.gov/pubmed/23956257

 

IVIg Preferred for Infection-Related ITP

Low platelets and the diagnosis of ITP can be associated with many infectious diseases such as HIV, H. pylori, hepatitis C and B, cytomegalovirus, Epstein–Barr virus, varicella zoster virus, and parvovirus B19. While corticosteroids (ex. Prednisone) are usually the first treatment given for low platelets, in the case of secondary ITP related to infections, IVIg may be a better choice. Corticosteroids suppress the immune system, just when the immune system is trying to fight off an infection.

Smíšková D et al. “Immune thrombocytopenia as a complication of acute infectious diseases - case reports”. Klin Mikrobiol Infekc Lek. 2013 Mar;19(1):15-8.
http://www.ncbi.nlm.nih.gov/pubmed/23945832

 

Hospitals, Insurance, and Medical Care

Big Variation in Doctor Payments

Some doctors in the US are paid by insurance companies more than twice what other doctors are paid for routine visits and maintenance procedures. The reimbursements were different for the same procedures, the same kind of visits, the same types of patients, and the same places of service. Geographic location explained only about one-third of the variation. To reach these conclusions, researchers looked at 40 million physician insurance claims from 2007, about 75% of them for office visits. While what a doctor is paid may not matter to patients, the resulting left-over costs can add to personal expenses.

Baker L et al. “Private insurers' payments for routine physician office visits vary substantially across the United States.” Health Aff (Millwood). 2013 Sep;32(9):1583-90.
http://www.ncbi.nlm.nih.gov/pubmed/24019363

Kelly JC. “Private Insurer Physician Payment Differences Unexplained.” Medscape Medical News. Sep 11, 2013.
http://www.medscape.com/viewarticle/810862 (free sign-on required)

 

Get Ready for the New Healthcare Law

Affordable Care Act

Major provisions of the Affordable Care Act (Obamacare) are scheduled to begin this October. That’s when individuals can have a closer look at the new healthcare choices for the coming year. The healthcare options vary by state, since states have flexibility in how they implement the healthcare insurance exchanges and how they deal with Medicaid. Here are three websites that can help you understand how the new law will affect you and perhaps save you money.

http://healthlawanswers.aarp.org/ - creates unique suggestions based on your location, gender, age, number of people in your household, income, and current health-insurance status.

http://rarediseases.org/patients-and-families/state-by-state-insurance-information - click on your state for a contact list and state-specific regulations

https://www.healthcare.gov/ - the official US healthcare site. “Answer a few questions to see if you qualify for lower costs.”

 

General Health and Medicine

Anti-Depressants Contribute to Bleeding

SSRIs (selective serotonin reuptake inhibitors), a common type of anti-depressant (think Prozac), can affect platelet function and promote blood loss. Multiple studies have shown that this type of drug can increase the chance of brain hemorrhage and stomach bleeding. Serotonin, a mood-elevating protein, is attached and carried by platelets. Serotonin on platelets is also involved in the clotting process. SSRIs block the serotonin from attaching to platelets, interfering with the ability of blood to clot.

Hulisz D. “Do SSRIs Cause Bleeding?” Medscape. Aug 20, 2013
http://www.medscape.com/viewarticle/809492 (free sign-on required)

 

Gut Health May Impact ITPColon X-ray

At any one time, 70% of the immune cells in the body can be found in the intestine. The bacteria and viruses in the gut (microbiota) can educate these immune cells and determine how they will behave in other parts of the body when they circulate throughout the system. This gut education process includes t-cells, the cells linked to ITP. Diet, hormones, and the environment, among other things, can affect the gut microbiota which, in turn, can impact your mood, your behavior, and your health.

Konkel. L. “The Environment Within: Exploring the Role of the Gut Microbiome in Health and Disease.” Environ Health Perspect. Sept. 2013.
http://ehp.niehs.nih.gov/121-A276/

 

 

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