RESPONSE TO STEROID TREATMENT AND FACTORS AFFECTING TREATMENT RESPONSE AMONG ADULTS WITH IMMUNE THROMBOCYTOPENIA AT SPHMMC, ADDIS ABABA

Abstract

Abstract Background: Immune Thrombocytopenia is one of the common acquired hematologic conditions which affects an average of two in 100,000 adults per year. Evidence shows that majority of patients who have indications for treatment will be started on steroids as a first line treatment and good response rates have been documented. However, results varied from one setup to another and studies done in our country are very limited. But it is important to have local data in order to implement effective treatment strategies and apply standardized clinical practice based on local factors that significantly and directly affect our patients. It can also be used as the basis for future planning, development of institutional protocols, and guidelines to manage immune thrombocytopenia. Objectives: The objective of the study was to assess the response to treatment and factors associated among adult Immune thrombocytopenia patients on follow-up at St. Paul Hospital Millennium Medical College Methods: A facility-based analytical cross-sectional study was conducted on 118 adult patients with Immune thrombocytopenia, who visited the outpatient department of St. Paul hospital Hematology clinics from September 2021 up to October 2022 G.C. Data was collected through an interview-administered structured questionnaire from all patients who visited the hospital during the data collection time. The collected data was entered into Epi Info and analyzed using SPSS version 21 for Windows. The Chi-square test was used to determine the association between dependent and independent variables. Multinomial logistic regression was done to identify factors associated with response to steroid treatment. Adjusted Odds Ratio (AOR), 95% CI for AOR and p-value of less than 0.05 were used to declare statistical significance. Result: A total of 118 patients’ data were participated in this study. For having platelet count above 30,000 at 6 months relative to non-response, the relative risk for response at 12 months would be expected to increase by 10.4 given the other variables are held constant (AOR = 10.4 ( 1.12,96.62) , 95% CI ,p- Value = .039). Similarly, patients with platelet counts above 100,000 at six months were more likely than no response at six months to have remission over no response at 12 months (AOR=7.33(1.28,42.07, 95% CI, p-Value=.025). In addition, patients with treatment duration between 6 months and 1 year were less likely than those with duration above 2 years to have Remission relative to No response (AOR= .04 95% CI= 0.004-0.409 , p- Value= .007). Conclusion and recommendations: Significant factor associated with response and remission of ITP at 12 months was found to be achieving sustained response at six months of therapy. This is consistent with findings in other countries. The findings can implicate the general pattern of response in our country but conclusions cannot be drawn about long term remission since the study duration was short and other studies suggest a high relapse rate. Thus, further studies need to be done to assess long term outcomes.