Relapse-free survival is progressively shortened in a subset of Black patients with immune-mediated TTP treated in the rituximab era
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 cou...
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Elsevier
2025-01-01
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| Series: | Blood Advances |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2473952924006967 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Ayotola Fatola |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-633b22fd93e34b8681507f5f656e5d41 |
| institution | Kabale University |
| issn | 2473-9529 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
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| series | Blood Advances |
| spelling | doaj-art-633b22fd93e34b8681507f5f656e5d412025-01-18T05:05:00ZengElsevierBlood Advances2473-95292025-01-0192417424Relapse-free survival is progressively shortened in a subset of Black patients with immune-mediated TTP treated in the rituximab eraAyotola Fatola0Michael D. Evans1Jenna Brown2Elizabeth Davis3Andrew Johnson4Ana G. Antun5Andrew M. Farland6Ryan Woods7Ara Metjian8Yara A. Park9Gustaaf de Ridder10Briana Gibson11Raj S. Kasthuri12Darla K. Liles13Susan Eubanks14Frank Akwaa15Todd Clover16Lisa Baumann Kreuziger17J. Evan Sadler18Meera Sridharan19Ronald S. Go20Keith R. McCrae21Harsh Vardhan Upreti22Ming Y. Lim23Nicole K. Kocher24Radhika Gangaraju25X. Long Zheng26Jay S. Raval27Camila Masias28Spero R. Cataland29Marshall Mazepa30Shruti Chaturvedi31Department of Medicine, Johns Hopkins University, Baltimore, MDClinical and Translational Science Institute, University of Minnesota, Minneapolis, MNDepartment of Medicine, Johns Hopkins University, Baltimore, MDDepartment of Medicine, University of Minnesota, Minneapolis, MNDepartment of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MNDepartment of Medicine, Emory University, Atlanta, GADepartment of Medicine, Wake Forest University, Winston-Salem, NCDepartment of Medicine, Wake Forest University, Winston-Salem, NCDepartment of Medicine, University of Colorado, Denver, CODepartment of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NCDepartment of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Pathology, Geisinger Medical Center, Danville, PADepartment of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC; Gulf Regional Pathologists, Mobile, ALDepartment of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NCDepartment of Medicine, East Carolina University, Greenville, NCDepartment of Medicine, East Carolina University, Greenville, NCDepartment of Medicine, University of Rochester, Rochester, NYDepartment of Hematology and Oncology, St. Charles Healthcare, Bend, ORVersiti Blood Center of Wisconsin, Milwaukee, WI; Department of Medicine, Medical College of Wisconsin, Milwaukee, WIDepartment of Medicine, Washington University, St. Louis, MODepartment of Medicine, Mayo Clinic, Rochester, MNDepartment of Medicine, Mayo Clinic, Rochester, MNDepartment of Medicine, Cleveland Clinic, Cleveland, OHDepartment of Medicine, The University of Texas Southwestern Medical Center, Dallas, TXDepartment of Medicine, The University of Utah, Salt Lake City, UTDepartment of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, MODepartment of Medicine, The University of Alabama at Birmingham, Birmingham, ALDepartment of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN; Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, MO; Institute of Reproductive Medicine and Developmental Sciences, University of Kansas Medical Center, Kansas City, MODepartment of Pathology, University of New Mexico, Albuquerque, NMDepartment of Hematology and Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FLDepartment of Medicine, The Ohio State University, Columbus, OHDepartment of Medicine, University of Minnesota, Minneapolis, MNDepartment of Medicine, Johns Hopkins University, Baltimore, MD; Correspondence: Shruti Chaturvedi, Division of Hematology, Johns Hopkins University School of Medicine, 720 Rutland Ave, Ross Research Bldg, Room 1025, Baltimore, MD 21205;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.http://www.sciencedirect.com/science/article/pii/S2473952924006967 |
| spellingShingle | 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 Relapse-free survival is progressively shortened in a subset of Black patients with immune-mediated TTP treated in the rituximab era Blood Advances |
| title | Relapse-free survival is progressively shortened in a subset of Black patients with immune-mediated TTP treated in the rituximab era |
| title_full | Relapse-free survival is progressively shortened in a subset of Black patients with immune-mediated TTP treated in the rituximab era |
| title_fullStr | Relapse-free survival is progressively shortened in a subset of Black patients with immune-mediated TTP treated in the rituximab era |
| title_full_unstemmed | Relapse-free survival is progressively shortened in a subset of Black patients with immune-mediated TTP treated in the rituximab era |
| title_short | Relapse-free survival is progressively shortened in a subset of Black patients with immune-mediated TTP treated in the rituximab era |
| title_sort | relapse free survival is progressively shortened in a subset of black patients with immune mediated ttp treated in the rituximab era |
| url | http://www.sciencedirect.com/science/article/pii/S2473952924006967 |
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