Unmet needs in the management of immune‐mediated thrombotic thrombocytopenic purpura and the potential role of caplacizumab in the UK—A modified‐Delphi study

Immune‐mediated thrombotic thrombocytopenic purpura (iTTP) is an ultra‐rare, blood‐clotting disorder. Management historically relies on plasma exchange and immunosuppression; however, a 10%–20% mortality rate is still observed. Caplacizumab binds to von Willebrand factor and directly inhibits platel...

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Bibliographic Details
Published in:EJHaem 2022-08, Vol.3 (3), p.619-627
Main Authors: Scully, Marie, Dutt, Tina, Lester, Will, Farrington, Emily, Lockwood, Stevie, Perry, Richard, Holmes, Steve
Format: Article
Language:English
Subjects:
ADAM protein
ADAMTS13
Agreements
Blood platelets
caplacizumab
Clinical trials
Clotting
Delphi method
Disease
Enzymes
Immunosuppression
Ischemia
Likert scale
management
Microvasculature
Mortality
Pharmacists
Platelet aggregation
Purpura
Sickle Cell, Thrombosis, and Benign Haematology
Thrombocytopenic purpura
Thrombosis
Thrombospondin
Thrombotic thrombocytopenic purpura
unmet need
Von Willebrand factor
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Summary:Immune‐mediated thrombotic thrombocytopenic purpura (iTTP) is an ultra‐rare, blood‐clotting disorder. Management historically relies on plasma exchange and immunosuppression; however, a 10%–20% mortality rate is still observed. Caplacizumab binds to von Willebrand factor and directly inhibits platelet aggregation; addition of caplacizumab to historical treatment induced faster resolution of platelet count in clinical trials. In 2019, a modified‐Delphi study was conducted with UK experts, to develop consensus statements on management of acute TTP and the potential role of caplacizumab. An unmet need was acknowledged, and areas requiring improvement included: time to diagnosis and treatment initiation; time to platelet normalisation (TTPN) during which patients remain at risk of persistent microvascular thrombosis and organ damage; and incidence of subsequent exacerbations and relapses. Caplacizumab addition to historical treatment within 24 h (after confirmatory ADAMTS13 [a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13] assay) would significantly reduce TTPN, which directly influences acute outcomes, with manageable bleeding risk and reduced burden on healthcare systems. Expert panellists agree that poor outcomes in iTTP largely result from failure to rapidly control microvascular thrombosis. Use of caplacizumab during a confirmed iTTP episode could offer better control and may plausibly improve long‐term outcomes. However, this consensus must be validated with further clinical trials and robust real‐world evidence.
ISSN:2688-6146
2688-6146
DOI:10.1002/jha2.435