Relapse treatments and outcomes
Of all patients treated for ITP relapses, three patients (23%) showed
complete response after different steroid treatment regimen in the
context of COVID-19 therapy, as following: methylprednisolone 40mg twice
daily for 10 days, dexamethasone 6mg daily for eight days, and
methylprednisolone 60mg daily for ten days. One patient (7.7%) required
romiplostim 3mcg/kg for one day in addition to prednisone 5mg for seven
days and dexamethasone 6mg for ten days. One patient (7.7%) achieved
partial response to dexamethasone 6mg for ten days and so recommended
initiating eltrombopag, however, the final decision was not to proceed
with eltrombopag because of the concern for hepatotoxicity side effect
and platelet count was trending up from the nadir of 17
x109/L. None of our relapsed patients required
IVIG. Among patients who were treated conservatively, complete response
achieved in 50% (4/8) and partial response achieved in 12.5% (1/8). Of
the remaining observed patients, 25% (2/8) of the patients had stable
platelet count and only one (7.7%) patient had a progressive decline in
platelet count and the patient opted for hospice due to life-limiting
illness.
Out of all patients with chronic ITP and COVID-19 infection, seven
(23.3%) death events happened. None of the patients died secondary to
bleeding complications. The main cause of death in all patients was
acute hypoxic respiratory failure. Five (71.4%) out of the total
patients who died had ITP relapses.