Antiplatelet Antibodies Do Not Predict the Response to Intravenous Immunoglobulins during Immune Thrombocytopenia

Antiplatelet Antibodies Do Not Predict the Response to Intravenous Immunoglobulins during Immune Thrombocytopenia

Thomas Rogier;Maxime Samson;Guillaume Mourey;Nicolas Falvo;Nadine Magy-Bertrand;Sethi Ouandji;Jean-Baptiste Picque;Hélène Greigert;Christelle Mausservey;Arthur Imbach;Thibault Ghesquière;Laurent Voillat;Denis Caillot;Eric Deconinck;Bernard Bonnotte;Sylvain Audia;Rogier, Thomas;Samson, Maxime;Mourey, Guillaume;Falvo, Nicolas;Magy-Bertrand, Nadine;Ouandji, Sethi;Picque, Jean-Baptiste;Greigert, Hélène;Mausservey, Christelle;Imbach, Arthur;Ghesquière, Thibault;Voillat, Laurent;Caillot, Denis;Deconinck, Eric;Bonnotte, Bernard;Audia, Sylvain;
journal of clinical medicine 2020 Vol. 9 pp. 1998-
251
rogier2020journalantiplatelet

Abstract

Immune thrombocytopenia (ITP) is a rare autoimmune disease due to autoantibodies targeting platelet glycoproteins (GP). The mechanism of platelet destruction could differ depending on the specificity of antiplatelet antibodies: anti-GPIIb/IIIa antibodies lead to phagocytosis by splenic macrophages, in a Fcγ receptor (FcγR)-dependent manner while anti-GPIb/IX antibodies induce platelet desialylation leading to their destruction by hepatocytes after binding to the Ashwell–Morell receptor, in a FcγR-independent manner. Considering the FcγR-dependent mechanism of action of intravenous immunoglobulins (IVIg), we assumed that the response to IVIg could be less efficient in the presence of anti-GPIb/IX antibodies. We conducted a multicentric, retrospective study including all adult ITP patients treated with IVIg who had antiplatelet antibodies detected between January 2013 and October 2017. Among the 609 identified, 69 patients were included: 17 had anti-GPIb/IX antibodies and 33 had anti-GPIIb/IIIa antibodies. The response to IVIg was not different between the patients with or without anti-GPIb/IX (88.2% vs. 73.1%). The response to IVIg was better in the case of newly diagnosed ITP (odds ratio (OR) = 5.4 (1.2–24.7)) and in presence of anti-GPIIb/IIIa (OR = 4.82 (1.08–21.5)), while secondary ITP had a poor response (OR = 0.1 (0.02–0.64)). In clinical practice, the determination of antiplatelet antibodies is therefore of little value to predict the response to IVIg.

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