在免疫性血小板减少症(ITP)患者中逐渐减少和停用血小板生成素受体激动剂(TPO-RA)方面建立泛欧共识,我们应用了三步Delphi技术,包括一对一的访谈和两轮在线调查。来自意大利的三名医疗保健专业人员(HCP),西班牙,英国成立了指导委员会(SC),为研究设计提供建议,小组成员的选择,和调查发展。文献综述也为共识声明的发展提供了信息。利克特量表用于收集小组成员共识水平的定量数据。代表9个欧洲国家的12位血液学家评估了121项陈述,涵盖三个类别:(1)患者选择;(2)逐渐减少和停药策略;(3)停药后管理。每个类别中约有一半的陈述达成了共识(32.2%;44.6%;66%)。小组成员同意患者的主要选择标准,患者参与决策,缩减战略,和后续标准。未达成共识的领域是成功停药的风险因素和预测因素,监测间隔,以及成功停药或复发率。这种缺乏共识标志着欧洲国家之间的知识和实践差距,并表明有必要制定临床实践指南,概述泛欧洲,以证据为基础的方法来逐渐减少和停止TPO-RA。
免疫性血小板减少症(ITP)是一种可能导致大面积瘀伤和过度出血的疾病。另一个迹象是类似皮疹的红紫色小点图案。ITP使用一类称为血小板生成素受体激动剂(TPO-RA)的药物治疗,其中包括Eltrombopag,avatrombopag,还有romiplostim.有时,即使患者停止服用药物,药物的有益效果也会持续,这意味着一些患者可以逐渐减少它。本文介绍了Delphi小组的结果-一种收集专家见解的研究方法-关于逐渐减少和停止TPO-RA。德尔福小组中有来自九个欧洲国家的12名医生,所有执业的血液学家都在ITP患者中逐渐减少和停止TPO-RA方面具有专业知识。在三轮调查中,小组成员总共得到了130份陈述。在第三轮结束时,52个陈述(40%)达成共识(回答模式≥80%“同意”),六个陈述(4.6%)达成了异议(回答模式≥80%“不同意”)。在尝试停药前将TPO-RA的剂量逐渐减少两到三个月的适当性达成了共识。小组还就考虑以较慢的方式(6至12个月)逐渐减少对TPO-RA的反应欠佳的患者达成共识。超过一半的调查声明没有达成共识或异议。这表明存在知识差距,并强调进行前瞻性,现实世界的证据研究,以确定最佳做法,并制定逐步减少和停止TPO-RA的泛欧指南。
To establish pan-European
consensus on tapering and discontinuing thrombopoietin receptor agonists (TPO-RAs) in patients with immune thrombocytopenia (ITP), we applied a three-step Delphi technique consisting of a one-to-one interview round and two online survey rounds. Three healthcare professionals (HCPs) from Italy, Spain, and the United Kingdom formed the Steering Committee (SC), which advised on study design, panelist selection, and survey development. A literature review also informed the development of the
consensus statements. Likert scales were used to collect quantitative data on panelists\' level of agreement. Twelve hematologists representing nine European countries assessed 121 statements spanning three categories: (1) patient selection; (2) tapering and discontinuation strategies; (3) post-discontinuation management. Consensus was reached on approximately half of the statements in each category (32.2%; 44.6%; 66%). Panelists agreed on patients\' main selection criteria, patients\' involvement in decision-making, tapering strategies, and follow-up criteria. Areas not reaching consensus were risk factors and predictors of successful discontinuation, monitoring intervals, and rates of successful discontinuation or relapse. This lack of consensus signals knowledge and practice gaps among European countries and suggests the need for the development of clinical practice
guidelines that outline a pan-European, evidence-based approach to tapering and discontinuing TPO-RAs.
Immune thrombocytopenia (ITP) is a condition that may cause extensive bruising and excessive bleeding. Another sign is a pattern of small reddish-purple dots resembling a rash. ITP is treated with a class of medications known as thrombopoietin receptor agonists (TPO-RAs), which include eltrombopag, avatrombopag, and romiplostim. Sometimes the beneficial effects of the medication last even after the patient stops taking it, which means that some patients can be tapered off it. This paper presents the results of a Delphi panel—a method of research that gathers insights from experts—about tapering and discontinuing TPO-RAs. There were 12 physicians from nine European countries on the Delphi panel, all practicing hematologists with expertise in tapering and discontinuing TPO-RAs in patients with ITP. Panelists were presented with a total of 130 statements over three survey rounds. At the end of Round Three, 52 statements (40%) achieved consensus (response pattern of ≥80% “Agree”), and six statements (4.6%) achieved dissensus (response pattern of ≥80% “Disagree”). Consensus was achieved on the appropriateness of tapering the dose of the TPO-RA for two to three months prior to attempting discontinuation. The panel also reached consensus on considering tapering in a slower fashion (six to 12 months) for patients showing suboptimal response to TPO-RAs. More than half the survey’s statements did not achieve
consensus or dissensus. This signals that knowledge gaps exist and highlights the importance of conducting prospective, real-world evidence studies to identify best practices and develop pan-European
guidelines for tapering and discontinuing TPO-RAs.