An Abbreviated Course of Therapeutic Plasma Exchange Does Not Affect Platelet Count Recovery or Durability in Patients With Immune Thrombotic Thrombocytopenic Purpura Receiving Caplacizumab.

Patients with immune thrombotic thrombocytopenic purpura (iTTP) receive daily therapeutic plasma exchange (TPE) and immunosuppression as first-line therapies. It is recommended that TPE be performed until clinical response is achieved, typically defined as platelet counts ≥ 150 × 10⁹/L for ≥ 2 consecutive days. The anti-von Willebrand factor agent caplacizumab is approved for patients with iTTP in combination with TPE and immunosuppression and has been shown to more rapidly normalize platelet counts and decrease exacerbations, refractoriness, and mortality. However, no studies have re-examined endpoints for TPE cessation with concomitant caplacizumab use. We compared patients with iTTP receiving daily TPE, immunosuppression, and caplacizumab who had the typically recommended TPE treatment course versus an abbreviated course with TPE discontinued before achieving platelet counts of 150 × 10⁹/L and observed no detriment with early TPE cessation. Additional high-quality studies re-evaluating daily TPE cessation endpoints are needed for patients with iTTP receiving caplacizumab.

Duke Scholars

Author Grace Ming Lee Medicine, Hematology