Patients with acute immune thrombocytopenia (ITP) had shorter hospital stays and fewer readmissions after receiving first-line dexamethasone therapy compared with those who received prednisone therapy. Sowda Ahmed, MD candidate at the University of Minnesota Medical School in Minneapolis, Minnesota, and colleagues, presented these findings at the Thrombosis & Hemostasis Summit of North America (THSNA) 2020 Virtual Conference.
“Previously, a multicenter randomized study found that dexamethasone had a greater overall response and shorter time to response compared to prednisone. However, there is no standard for choosing one treatment option over the other,” said Ms Ahmed.
The researchers retrospectively evaluated electronic medical records to compare outcomes after patients with ITP received first-line dexamethasone therapy or prednisone therapy from 2016 to 2019 at M Health Fairview, a large academic system with 13 hospitals, 59 primary care clinics, 11 urgent care centers, and 21 specialty clinics. Outcomes of interest were admission and readmission rates, hospital length of stays and number of complications. A readmission was considered as such if the primary problem was bleeding or severe thrombocytopenia.
Overall, 47 patients (mean age, 50 years; female-to-male ratio, 1.6; mean platelet count, 11,000 platelet/µL) with a diagnosis of acute ITP were identified. Nearly 75% of the patients (35/47) were admitted to the hospital for management.
More hospitalized patients were treated with prednisone (57%) compared with dexamethasone (43%), and those treated with prednisone had longer average hospital stays (4.45 days) compared with those treated with dexamethasone (3.9 days).
“Readmission rates for the prednisone group [were] twice that of the dexamethasone group,” Ms Ahmed said. More cardiovascular adverse events occurred in patients treated with prednisone (2 patients) compared with patients treated with dexamethasone (1 patient); whereas, more venous thromboembolic events were reported in the dexamethasone group (2 patients) compared with in the prednisone group (1 patient).
The team also estimated the financial savings per patient associated with shorter hospital stays. “With a decreased length of stay in patients treated with dexamethasone, we found that this led to a cost savings of about $1000 per patient, which we found quite significant,” said Ms Ahmed.
Limitations of the study included the small sample size, retrospective and single-center design, and lack of generalizability.
“As suggested by previously published data, we found that [the] dexamethasone group had a faster time to response hence a shorter hospital stay, but we also found that they had fewer readmissions,” concluded the authors. “Based on this data, it’s clear that the frontline corticosteroid choice has impact on the economic aspect of patient care as well as patient satisfaction and wellbeing, therefore, should factor in at the time of decisions for initial therapy choice.”
The team also created and implemented clinical decision support tools and carried out educational sessions with hospitalists and physicians to increase the use of dexamethasone. They plan to conduct future studies to longitudinally assess quality metrics and changes in practice among providers within their hospital network.
Ahmed S, Laschen M, Shah S. Impact of first line corticosteroid choice on patient outcomes in acute immune thrombocytopenia. Abstract presented at: THSNA 2020 Thrombosis & Hemostasis Summit of North America; October 27-30, 2020. Abstract 70.