Relapse-free survival is progressively shortened in a subset of Black patients with immune-mediated TTP treated in the rituximab era
Year: 2024
Type: article
Study design: Observational Study
Abstract: ABSTRACT: Immune thrombotic thrombocytopenic purpura (iTTP) is a chronically relapsing disorder caused by autoantibody-mediated deficiency of ADAMTS13. Rituximab is frequently administered to prevent relapses, but whether the durability of rituximab effect is maintained with subsequent treatment courses has not been studied. Using the United States Thrombotic Microangiopathy Consortium (USTMA) retrospective iTTP registry, we evaluated clinical relapse-free survival (RFS) with subsequent courses of rituximab treatment in multiply relapsing patients. Separately, we evaluated overall RFS (composite of time to clinical relapse, ADAMTS13 relapse, or preemptive rituximab) in a prospective iTTP cohort from the Johns Hopkins University and the University of Minnesota. In the USTMA registry, median clinical RFS was shorter after the second or subsequent rituximab-treated episode than the first (2.1 vs 6.0 years; P = .04). White patients' clinical relapse risk after the second and subsequent rituximab courses was not significantly different compared with the first (hazard ratio [HR], 1.86; 95% confidence interval [CI], 0.22-15.80; P = .57), whereas for Black patients, clinical relapse risk was significantly higher after the second or subsequent courses (HR, 2.82; 95% CI, 1.52-5.24; P = .001). In the prospective cohort, overall RFS progressively shortened after each episode of rituximab treatment with the first episode having the longest RFS (2.8 years; interquartile range, 2.0-6.0) and this loss of response durability was most pronounced in Black patients. The durability of rituximab's effect declines with subsequent treatments, which is more pronounced in Black patients, who may benefit from closer monitoring and alternative immunomodulatory approaches such as maintenance rituximab and consideration of other agents.
Source: Blood Advances
Authors: Ayotola Fatola, Michael D. Evans, Jenna Brown, Elizabeth Davis, Andrew Johnson, Ana G. Antun, Andrew M. Farland, Ryan Woods, Ara Metjian, Yara A. Park, Gustaaf de Ridder, Briana Gibson, Raj S. Kasthuri, Darla K. Liles, Susan Eubanks, Frank Akwaa, Todd Clover, Lisa Baumann Kreuziger, J. Evan Sadler, Meera Sridharan, Ronald S. Go, Keith R. McCrae, Harsh Vardhan Upreti, Ming Y. Lim, Nicole K. Kocher, Radhika Gangaraju, X. Long Zheng, Jay S. Raval, Camila Masias, Spero R. Cataland, Marshall Mazepa, Shruti Chaturvedi
Institutions: Johns Hopkins University, Johns Hopkins Hospital, University of Minnesota, Emory University, Wake Forest University Health Sciences, Wake Forest University, Duke University, Duke Medical Center, University of Colorado Denver, University of North Carolina at Chapel Hill, Geisinger Medical Center, East Carolina University, University of Rochester Medicine, University of Rochester, St. Charles Medical Center, Medical College of Wisconsin, Versiti Blood Center of Wisconsin, Washington University in St. Louis, Mayo Clinic, Cleveland Clinic, The University of Texas Southwestern Medical Center, University of Utah, University of Alabama at Birmingham, University of Kansas Medical Center, University of New Mexico, Baptist Hospital of Miami, Baptist Health South Florida, The Ohio State University
Language: English
Subfield: Immunology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $3,000
Awards: G1032411263, G1326672414, G1548437755, Pathogenesis of thrombotic microangiopathies, G235943272, G2670169712, G3573251375, G3780115445, G4622355042, G467860943, ADAMTS13 and Late Neurologic Morbidity after Thrombotic Thrombocytopenic Purpura, G5150090606, G608092659, G631129105, G9000076473, G9000112302, G9000178988, G906911976
OpenAlex ID: W4404945128