An evaluation of overall effectiveness and treatment satisfaction with intravenous immunoglobulin among patients with immune thrombocytopenia.

BACKGROUND: A global assessment of patient satisfaction that considers therapeutic effect, toxicities, and convenience is needed to evaluate the acceptability of intravenous immunoglobulin (IVIG) as a treatment for patients with immune thrombocytopenia (ITP). STUDY DESIGN AND METHODS: We performed a cross-sectional pilot study to assess the feasibility and usefulness of a treatment satisfaction questionnaire for adult patients with ITP receiving IVIG in an academic hematology clinic. Treatment satisfaction was evaluated by administration of a validated survey-based tool 7 days after IVIG administration. The tool assessed treatment satisfaction across four domains (effectiveness, toxicity, convenience, and global satisfaction); results were summarized with mean scores. RESULTS: Twelve patients were enrolled (nine females; median age, 44 years; interquartile range, 35-69 years). Mean platelet increment after infusion was 54.2 × 10(9) /L (SD, 47.6 × 10(9) /L). Treatment satisfaction scores were highest in the side effect burden domain (88.2/100; SD, 19.3; higher scores indicate a lower burden of side effects). Six participants reported IVIG-associated toxicities; most were "slightly" or "not at all" dissatisfied by the impact of side effects. The domain with the lowest score was convenience (62.0/100; SD, 24.7). CONCLUSION: The assessment of treatment satisfaction using a survey-based assessment tool was feasible for patients receiving IVIG and provided meaningful results that discriminated between domains. Patients found IVIG treatment to be inconvenient, but were satisfied with its tolerability as an ITP treatment. Larger studies are needed to determine the precise impact on each domain and the reproducibility of study results. Patient satisfaction scores can be used to compare different ITP treatments.

Effect of a thrombopoietin receptor agonist on use of intravenous immune globulin in patients with immune thrombocytopenia.

BACKGROUND: Thrombopoietin receptor agonists are new treatments for patients with chronic immune thrombocytopenia (ITP). How one of these agent, romiplostim, has impacted practice patterns, especially the use of intravenous immune globulin (IVIG), has not been evaluated outside of clinical trials. STUDY DESIGN AND METHODS: This was a retrospective cohort study of adult ITP patients treated with romiplostim in four Canadian centers. Patients had primary or secondary ITP and were followed for 1 year before starting weekly romiplostim treatment. We compared IVIG use, clinical outcomes, and cost before and after romiplostim. RESULTS: Twenty-nine patients with ITP received romiplostim. Median age was 54 years (interquartile range [IQR], 45-63 years) and patients had a median of two prior ITP treatments (IQR, 1-4) including splenectomy (n = 7). Median platelet (PLT) count was 23 × 10(9) before and 124 × 10(9) after romiplostim. Median duration of romiplostim treatment was 3.7 months. Patients used a median of two IVIG infusions per year before and 0.7 per year after starting romiplostim (p = 0.16). For patients who received weekly romiplostim for at least 1 month (n = 19), IVIG infusions were three (IQR, 1-5) per year before and 0.7 (IQR, 0.4-1.6) per year after romiplostim. Results were squewed by two high IVIG users. Nineteen (66%) patients discontinued romiplostim treatment during follow-up because of lack of response (n = 8), sustained response (n = 5), toxicities (n = 4), or response to splenectomy (n = 2). Overall health care costs were similar before and after romiplostim when concomitant treatments, nursing resources, and hospitalizations were considered. CONCLUSIONS: Romiplostim was associated with improved PLT counts and fewer IVIG infusions for most ITP patients. In practice, romiplostim was generally not continued long term and was cost neutral for overall ITP management.

Prevalence of Intimate Partner Violence Among South Asian Women Living in Southern Ontario.

Intimate partner violence (IPV) affects 4 in 10 women in North America in their lifetime and 13-27 % in the past year. The basis for estimates stems largely from studies involving Caucasian women. Less is known about other minority populations such as South Asian women. This study aimed to assess the prevalence of IPV in the past year among South Asian women living in Southern Ontario. We conducted a survey of South Asian women living in Southern Ontario. All adult self-identified South Asian women attending a cultural event celebrating South Asian women who could understand English or Punjabi were eligible to participate. The survey contained three IPV prevalence questions adapted from the Woman Abuse Screening Tool. A total of 188 women (45 % of potentially eligible women) participated. Nearly 1 in 5 women reported IPV within the past year (19.3 %, 95 % CI 13.9-26.1 %). In this study single women were significantly more likely to have experienced IPV in the past year compared to married women (p = 0.035). Self-identified immigrant and non-immigrant South Asian women in this sample of women living in Southern Ontario experienced violence in proportions comparable to the general population. Programs for women should ensure accessibility and support of all ethnicities given equivalent rates of violence in the community.