TY - JOUR
T1 - COVID-19 vaccination in patients with immune thrombocytopenia
AU - Visser, Chantal
AU - Swinkels, Maurice
AU - van Werkhoven, Erik D.
AU - Nanne Croles, F.
AU - Noordzij-Nooteboom, Heike S.
AU - Eefting, Matthijs
AU - Last-Koopmans, Suzanne M.
AU - Idink, Cecile
AU - Westerweel, Peter E.
AU - Santbergen, Bart
AU - Jobse, Pieter A.
AU - RECOVAC-IR Consortium
AU - Baboe, Fazil
AU - te Boekhorst, Peter A. W.
AU - Leebeek, Frank W. G.
AU - Levin, Mark-David
AU - Kruip, Marieke J. H. A.
AU - Gerard Jansen, A. J.
N1 - Funding Information: Conflict-of-interest disclosure: P.A.W.t.B. received speaker’s fee from, and is a member of the advisory boards for, Novartis and Sanofi. F.W.G.L. has received research support from CSL Behring and Shire/Takeda for performing the Willebrand in the Netherlands study; has acted as a consultant for uniQure, Novo Nordisk, and Shire/ Takeda in exchange for fees paid to the institution; has received travel support from Sobi; and is member of the Data Safety Monitoring Board for a study sponsored by Roche. M.J.H.A.K. has received unrestricted grants, paid to the department for research outside of the scope of this work, from Bayer and Daiichi Sankyo and has received a speaker’s fee, paid to the department, from Bayer. A.J.G.J. has received speaker’s fees from, and has had travel costs paid by, 3SBio, Amgen, and Novartis; has served on an international advisory board for Novartis; and has received research funding from CSL Behring. The remaining authors declare no competing financial interests. Publisher Copyright: © 2022 by The American Society of Hematology.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - Immune thrombocytopenia (ITP) is an acquired autoimmune disorder that is characterized by low platelet count and increased bleeding risk. COVID-19 vaccination has been described as a risk factor for de novo ITP, but the effects of COVID-19 vaccination in patients with ITP are unknown. We aimed to investigate the effects of COVID-19 vaccination in patients with ITP on platelet count, bleeding complications, and ITP exacerbation ($50% decline in platelet count, or nadir platelet count, 30 3 109/L with a .20% decrease from baseline, or use of rescue therapy). Platelet counts in patients with ITP and healthy controls were collected immediately before and 1 and 4 weeks after the first and second vaccinations. Linear mixed-effects modeling was applied to analyze platelet counts over time. We included 218 patients with ITP (50.9% female; mean age, 55 years; and median platelet count, 106 3 109/L) and 200 healthy controls (60.0% female; mean age, 58 years; median platelet count, 256 3 109/L). Platelet counts decreased by 6.3% after vaccination. We did not observe any difference in decrease between the groups. Thirty patients with ITP (13.8%; 95% confidence interval [CI], 9.5-19.1) had an exacerbation and 5 (2.2%; 95% CI, 0.7-5.3) suffered from a bleeding event. Risk factors for ITP exacerbation were platelet count, 50 3 109/L (odds ratio [OR], 5.3; 95% CI, 2.1-13.7), ITP treatment at time of vaccination (OR, 3.4; 95% CI, 1.5-8.0), and age (OR, 0.96 per year; 95% CI, 0.94-0.99). Our study highlights the safety of COVID-19 vaccination in patients with ITP and the importance of the close monitoring of platelet counts in a subgroup of patients with ITP. Patients with ITP with exacerbation responded well on therapy.
AB - Immune thrombocytopenia (ITP) is an acquired autoimmune disorder that is characterized by low platelet count and increased bleeding risk. COVID-19 vaccination has been described as a risk factor for de novo ITP, but the effects of COVID-19 vaccination in patients with ITP are unknown. We aimed to investigate the effects of COVID-19 vaccination in patients with ITP on platelet count, bleeding complications, and ITP exacerbation ($50% decline in platelet count, or nadir platelet count, 30 3 109/L with a .20% decrease from baseline, or use of rescue therapy). Platelet counts in patients with ITP and healthy controls were collected immediately before and 1 and 4 weeks after the first and second vaccinations. Linear mixed-effects modeling was applied to analyze platelet counts over time. We included 218 patients with ITP (50.9% female; mean age, 55 years; and median platelet count, 106 3 109/L) and 200 healthy controls (60.0% female; mean age, 58 years; median platelet count, 256 3 109/L). Platelet counts decreased by 6.3% after vaccination. We did not observe any difference in decrease between the groups. Thirty patients with ITP (13.8%; 95% confidence interval [CI], 9.5-19.1) had an exacerbation and 5 (2.2%; 95% CI, 0.7-5.3) suffered from a bleeding event. Risk factors for ITP exacerbation were platelet count, 50 3 109/L (odds ratio [OR], 5.3; 95% CI, 2.1-13.7), ITP treatment at time of vaccination (OR, 3.4; 95% CI, 1.5-8.0), and age (OR, 0.96 per year; 95% CI, 0.94-0.99). Our study highlights the safety of COVID-19 vaccination in patients with ITP and the importance of the close monitoring of platelet counts in a subgroup of patients with ITP. Patients with ITP with exacerbation responded well on therapy.
UR - http://www.scopus.com/inward/record.url?scp=85126885423&partnerID=8YFLogxK
U2 - https://doi.org/10.1182/BLOODADVANCES.2021006379
DO - https://doi.org/10.1182/BLOODADVANCES.2021006379
M3 - Article
C2 - 34941989
SN - 2473-9529
VL - 6
SP - 1637
EP - 1644
JO - Blood advances
JF - Blood advances
IS - 6
ER -