Treatment patterns and safety outcomes after splenectomy or thrombopoietin receptor agonists as second-line therapy for immune thrombocytopenia: Korean claims-based study.
4 affiliations
- 1Graduate School of Software and Artificial Intelligence Convergence, Korea University, Seoul, Republic of Korea.
- 2Division of Hematology-Oncology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
- 3Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
- 4Department of Obstetrics & Gynecology, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Abstract
Background
Splenectomy and thrombopoietin receptor agonists (TPO-RAs) are recommended second-line therapies for immune thrombocytopenia. Although guidelines recommend tailoring second-line treatments to patient characteristics, this approach is often unclear in real-world practice.Objectives
We examined claims-based time to next treatment (TTNT) and safety outcomes after splenectomy or TPO-RA as a second-line therapy using nationally representative Korean claims data.Methods
Patients diagnosed with immune thrombocytopenia between 2002 and 2021 were included. From the eligible cohort, we identified patients whose index second-line treatment was splenectomy (group 1) or TPO-RA without prior splenectomy (group 2). Propensity score matching was performed between patients in both groups who had received corticosteroids as first-line treatment.Results
After matching, 447 group 1 and 57 group 2 patients were analyzed. Subsequent treatment was administered to 82.3% and 61.4% of patients in groups 1 and 2, respectively. Median TTNTs were 5.80 and 3.03 months in groups 1 and 2, respectively. Estimated TTNT curves diverged after 24 months, with a longer TTNT observed in the TPO-RA group. Pneumococcal infections occurred in 3.1% of patients in group 1 and none in group 2. Venous thromboembolism (VTE) occurred in 10.5% and 15.7% of patients in groups 1 and 2, respectively. The observed time to VTE was shorter in group 2 than in group 1.Conclusion
Patients treated with TPO-RAs as a second-line therapy showed a longer TTNT after 24 months, whereas VTE occurred earlier in the TPO-RA group. However, these findings should be interpreted with caution because of residual confounding.
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BibTeX
@article{lim2026treatment,
title = {{Treatment patterns and safety outcomes after splenectomy or thrombopoietin receptor agonists as second-line therapy for immune thrombocytopenia: Korean claims-based study.}},
author = {Hyung-Jun Lim and Kunye Kwak and Changgon Kim and Yoon Seok Choi and Yong Park and Byung Soo Kim and Ki Hoon Ahn and Ka-Won Kang},
journal = {Research and practice in thrombosis and haemostasis},
year = {2026},
month = sep,
doi = {10.1016/j.rpth.2026.106992},
url = {https://europepmc.org/article/MED/42927077},
note = {CC BY},
}
RIS
TY - JOUR
TI - Treatment patterns and safety outcomes after splenectomy or thrombopoietin receptor agonists as second-line therapy for immune thrombocytopenia: Korean claims-based study.
AU - Hyung-Jun Lim
AU - Kunye Kwak
AU - Changgon Kim
AU - Yoon Seok Choi
AU - Yong Park
AU - Byung Soo Kim
AU - Ki Hoon Ahn
AU - Ka-Won Kang
PY - 2026
DA - 2026/09/29
JO - Research and practice in thrombosis and haemostasis
DO - 10.1016/j.rpth.2026.106992
UR - https://europepmc.org/article/MED/42927077
AB - Background Splenectomy and thrombopoietin receptor agonists (TPO-RAs) are recommended second-line therapies for immune thrombocytopenia. Although guidelines recommend tailoring second-line treatments to patient characteristics, this approach is often unclear in real-world practice.Objectives We examined claims-based time to next treatment (TTNT) and safety outcomes after splenectomy or TPO-RA as a second-line therapy using nationally representative Korean claims data.Methods Patients diagnosed with immune thrombocytopenia between 2002 and 2021 were included. From the eligible cohort, we identified patients whose index second-line treatment was splenectomy (group 1) or TPO-RA without prior splenectomy (group 2). Propensity score matching was performed between patients in both groups who had received corticosteroids as first-line treatment.Results After matching, 447 group 1 and 57 group 2 patients were analyzed. Subsequent treatment was administered to 82.3% and 61.4% of patients in groups 1 and 2, respectively. Median TTNTs were 5.80 and 3.03 months in groups 1 and 2, respectively. Estimated TTNT curves diverged after 24 months, with a longer TTNT observed in the TPO-RA group. Pneumococcal infections occurred in 3.1% of patients in group 1 and none in group 2. Venous thromboembolism (VTE) occurred in 10.5% and 15.7% of patients in groups 1 and 2, respectively. The observed time to VTE was shorter in group 2 than in group 1.Conclusion Patients treated with TPO-RAs as a second-line therapy showed a longer TTNT after 24 months, whereas VTE occurred earlier in the TPO-RA group. However, these findings should be interpreted with caution because of residual confounding.
SN - 2475-0379
ER -