title: Newly diagnosed immune thrombocytopenia adults: Clinical epidemiology, exposure to treatments, and evolution. Results of the CARMEN multicenter prospective cohort.
abstract: The clinical epidemiology of immune thrombocytopenia (ITP) is not well known in adults. This study was aimed at assessing the clinical epidemiology of incident ITP adults, the factors associated with chronicity and exposure to treatments. This study was conducted in the CARMEN registry, a multicentric prospective cohort aimed at including all newly diagnosed ITP adults in the French Midi-Pyrénées region, South of France (3 million inhabitants) from June 2013. Descriptive analyses and multivariate logistic regression models were conducted. Out of 121 newly diagnosed ITP until December 2014, 113 patients were followed in the region and gave informed consent. Median age was 65 years. Half of the patients were female, 20.3% had a secondary ITP, 50.4% had a Charlson's score ≥1, median platelet count was 17 × 109/L; 50.9% had bleeding symptoms, including 2 severe gastrointestinal tract and 1 intracranial bleedings; 21.4% had another autoimmune disease and 20.3% experienced an infection within the six weeks before ITP onset. Persistency and chronicity rates were 68.2% and 58.7%, respectively. Antinuclear antibodies were associated with chronicity (OR: 2.89, 95% CI: 1.08-7.74). Sixty-eight (60.2%) patients were treated during the week following the diagnosis. Factors associated with the use of intravenous corticosteroids were secondary ITP and high bleeding score. Those associated with the use of intravenous immunoglobulin (IVIg) were a high bleeding score and low platelet count. In conclusion, severe bleeding is rare at ITP onset. Associated autoimmune diseases and recent infections were frequent. Antinuclear antibodies seem predictors of chronicity. Intravenous corticosteroids and IVIg were frequently used.
authors.affiliation: Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, F-31059, France.|UMR1027, Inserm, Université de Toulouse, Toulouse, F-31073, France.|CIC 1436, Centre Hospitalier Universitaire de Toulouse, Toulouse, F-31073, France.
authors.forename: Guillaume
authors.identifier: http://orcid.org/0000-0001-9953-4640
authors.initials: G
authors.lastname: Moulis
authors.affiliation: CIC 1436, Centre Hospitalier Universitaire de Toulouse, Toulouse, F-31073, France.
authors.forename: Johanne
authors.initials: J
authors.lastname: Germain
authors.affiliation: Service de Médecine Interne, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, F-31100, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Comont
authors.affiliation: Centre Hospitalier de Rodez, Service de Médecine Interne, Rodez, F-12000, France.
authors.forename: Natacha
authors.initials: N
authors.lastname: Brun
authors.affiliation: Centre Hospitalier de Bigorre, Service de Médecine Interne, Tarbes, F-65000, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Dingremont
authors.affiliation: Centre Hospitalier de Lourdes, Service de Médecine Interne, Lourdes, F-65107, France.
authors.forename: Brice
authors.initials: B
authors.lastname: Castel
authors.affiliation: Centre Hospitalier d'Auch, Service de Médecine Interne, Auch, F-32000, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Arista
authors.affiliation: Service de Médecine Interne, Centre Hospitalier Universitaire de Toulouse, Toulouse, F-31059, France.|UMR1027, Inserm, Université de Toulouse, Toulouse, F-31073, France.|CIC 1436, Centre Hospitalier Universitaire de Toulouse, Toulouse, F-31073, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Sailler
authors.affiliation: UMR1027, Inserm, Université de Toulouse, Toulouse, F-31073, France.|CIC 1436, Centre Hospitalier Universitaire de Toulouse, Toulouse, F-31073, France.|Service de Pharmacologie Médicale et Clinique, Centre Midi-Pyrénées de PharmacoVigilance, de Pharmacoépidémiologie et d'Informations sur le Médicament, Centre Hospitalier Universitaire de Toulouse, Toulouse, F-31059, France.
authors.forename: Maryse
authors.initials: M
authors.lastname: Lapeyre-Mestre
authors.affiliation: Service de Médecine Interne, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, F-31100, France.
authors.forename: Odile
authors.initials: O
authors.lastname: Beyne-Rauzy
authors.affiliation: Service de Médecine Interne, Centre National de Référence pour les Cytopénies Auto-Immunes de l'Adulte, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, F-94010, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Godeau
authors.affiliation: Service de Médecine Interne, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, F-31100, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Adoue
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002908:Chronic Disease; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance; D011446:Prospective Studies; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012042:Registries; D012307:Risk Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D007155:Immunologic Factors