Open AccessImmune thrombotic thrombocytopenic purpura: Personalized therapy using ADAMTS‐13 activity and autoantibodies
Author(s) -
Palandri Francesca,
Di Pietro Christian,
Ricci Francesca,
Tazzari Pier Luigi,
Randi Vanda,
Bartoletti Daniela,
Cavo Michele,
Vianelli Nicola,
Auteri Giuseppe
Publication year - 2021
Publication title -
research and practice in thrombosis and haemostasis
Language(s) - English
Resource type - Journals
ISSN - 2475-0379
DOI - 10.1002/rth2.12606
Subject(s) - rituximab , medicine , autoantibody , adamts13 , vedolizumab , discontinuation , thrombotic thrombocytopenic purpura , adamts , immunology , intensive care medicine , antibody , disease , platelet , inflammatory bowel disease , thrombospondin , metalloproteinase , matrix metalloproteinase
Recently, treatment of immune‐mediated thrombotic thrombocytopenic purpura (ITTP) has changed with the advent of caplacizumab in clinical practice. The International Working Group (IWG) has recently integrated the ADAMTS‐13 activity/autoantibody monitoring in consensus outcome definitions. We report three ITTP cases during the coronavirus disease 2019 pandemic, that received a systematic evaluation of ADAMTS‐13 activity and autoantibodies. We describe how the introduction of caplacizumab and ADAMTS‐13 monitoring could change the management of ITTP patients and discuss whether therapeutic choices should be based on the clinical response alone. ADAMTS‐13 activity/antibodies were assessed every 5 days. Responses were evaluated according to updated IWG outcome definitions. These kinetics, rather than clinical remission, guided the therapy, allowing early and safe caplacizumab discontinuation and sensible administration of rituximab. Caplacizumab was cautiously discontinued after achieving ADAMTS‐13 complete remission. These cases illustrate that prospective ADAMTS‐13 evaluation and use of updated IWG definitions may improve real‐life patients’ management in the caplacizumab era.