Therapy of Chronic ITP - The Patients’ Perspective in Germany.

Introduction: Adult ITP is a chronic disease. Many patients do not achieve remission despite immunosuppressive therapy. After 1^st line therapy with steroids and immunoglobulins splenectomy is usually offered as 2^nd line therapy, even to thrombocytopenic patients without bleeding symptoms. However, several non-surgical treatment options have been available for many years and recently anti-CD20 antibodies (rituximab) and anti-D (Cooper, Blood 2002) have been added to this list. This study was intended to asses which treatments are usually offered to patients in Germany.

Methods: In June 2004 and February 2005 we sent out a questionnaire that was returned by 80 patients. 7 questionnaires were excluded because of patient age (<12 y) or minor thrombocytopenia (platelets >100.000/μl).

Results: Age (median 50 years) and gender distribution (38% m, 62% f) are as expected for chronic ITP. Median duration of disease is 5 years (range 1–43 years). 27% of the patients have experienced gastrointestinal/urogenital bleeding, 12% had CNS or eye bleeds. 92% of the patients had been treated with steroids and 24% were splenectomized. Only 31% had been informed by their physicians of rituximab and 12% of anti-D. 35% of the patients had exclusively been informed about steroids, immunoglobulins and splenectomy. 45% of patients had the impression that cost of treatment affected their therapy options.

Conclusions: ITP is a chronic condition and patient histories extend over many years. Standard therapies comprise steroids, i.v. immunoglobulins, and splenectomy. However, splenectomy has a considerable long-term failure rate (33%, Kojouri Blood 2004). Many patients are thrombocytopenic but have little or no bleeding symptoms. Particularly those patients are reluctant to undergo surgery as 2^nd line therapy and prefer trying a non-surgical approach first. Anti-D and rituximab are not covered by public health insurance. It is possible that insurance reimbursement policies restrict treatments offered to ITP patients in Germany.