Results from the immune thrombocytopenia (ITP) World Impact Survey (I‐WISh) suggest significant alignment among patients and physicians about ITP symptom burden, though the frequency and severity of fatigue appears to be underappreciated by physicians, according to a paper published in the American Journal of Hematology.

Primary ITP is linked with reduced health-related quality of life (HRQOL). While patients normally receive a standard first-line therapy of corticosteroids, intravenous immunoglobulin, and anti-D immunoglobulin, second-line treatments depend on both physician and patient preferences, which require that physicians be aware of how treatments might affect patient HRQOL.

To determine how ITP and ITP treatments can affect patients’ lives generally, including HRQOL, researchers conducted the I-WISh study, which explored: “1) the diagnostic pathway for patients with ITP, and 2) patient and physician perceptions of symptoms and disease management.”

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Overall, responses from 1507 patients and 472 physicians from 13 countries were included in the analysis. At baseline, the mean patient age was 46.9 years; 975 patients (65%) were women, the median amount of time patients had had ITP was 5 years. Of the 1503 results for patients self-reported current health state, 957 patients (64%) scored highly on the 7-point Likert overall health scale. A total of 1234 patients reported symptom burden at diagnosis. Of this population, low, moderate, high, and very high symptom burden was reported in 30%, 22%, 23%, and 25% of patients, respectively. Of all 1507 patients, 661 (44%) were working full-time.

Among all respondents, 22% had a delayed diagnosis, and 73% of these patients felt anxious because of the delay. Although 30% of physicians rated fatigue as a low priority compared with other symptoms, 58% of patients rated this symptom as the most frequent at diagnosis, and 73% rated it as the most severe. Patients were most likely to report still requiring resolution at survey completion, with 46% of patients still wanting this symptom resolved.

Patients were, however, aligned on other symptoms, and on diagnosis and treatment decision-making, including in the use of corticosteroids.

“These findings should be integrated into the clinical management of each patient with ITP in an individual fashion according to each patient’s needs,” the investigators wrote. “Further research, including I-WISh 2.0, is needed to assess and hopefully verify these exploratory findings through an appropriately powered, hypothesis-driven methodology linking the clinical to the quality of life and fatigue-related issues,” the authors concluded.

Disclosures: Some authors have declared affiliations with or received funding from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.


Cooper N, Kruse A, Kruse C, et al. Immune thrombocytopenia (ITP) World Impact Survey (I-WISh): patient and physician perceptions of diagnosis, signs and symptoms, and treatment. Am J Hematol. Published online November 10, 2020. doi:10.1002/ajh.26045