{"id":698,"date":"2010-11-15T17:44:52","date_gmt":"2010-11-15T16:44:52","guid":{"rendered":"http:\/\/www.pjh.fr\/wordpress\/?p=698"},"modified":"2011-10-19T01:39:01","modified_gmt":"2011-10-18T23:39:01","slug":"romiplostim-ou-standard-care-dans-le-pti-cest-quoi-le-standard-care","status":"publish","type":"post","link":"http:\/\/www.pjh.fr\/wordpress\/?p=698","title":{"rendered":"Romiplostim ou \u00ab\u00a0standard care\u00a0\u00bb dans le PTI&#8230; C&rsquo;est quoi le standard care ?"},"content":{"rendered":"<p>Un article publi\u00e9 dans le NEJM du 11 Novembre \u00ab\u00a0compare\u00a0\u00bb l&#8217;emploi de la ROMIPLOSTIM (agoniste de la thrombopo\u00ef\u00e9tine) au \u00ab\u00a0standard of care\u00a0\u00bb du PTI&#8230; D\u00e9j\u00e0 au titre \u00e7a commence mal : what is the standard of care of TPI ?<\/p>\n<p>En r\u00e9sum\u00e9 : 234 patients avec un PTI n&rsquo;ayant pas \u00e9t\u00e9 spl\u00e9nectomis\u00e9 ayant re\u00e7u au moins une ligne de traitement (rassurez-vous, la plupart ont re\u00e7u des cortico\u00efdes)<br \/>\n&#8211; 157 patients recoivent de la Romiplostim (le hic, c&rsquo;est que 44% d&rsquo;entre eux re\u00e7oivent aussi quelque chose d&rsquo;autre pendant l&rsquo;essai&#8230;)<br \/>\n&#8211; 77 le traitement dit standard du PTI (mais c&rsquo;est quoi ? en pratique, cortico\u00efdes et\/ou Immunoglobulines et\/ou Rituximab etc&#8230;<\/p>\n<p>J&rsquo;avoue rester assez perplexe sur ce type d&rsquo;\u00e9tude et sur le fait d&rsquo;en voir passer dans le NEJM dont on ne concluera pas grand chose \u00e0 part que la romiplostim marche bien avant spl\u00e9nectomie, probablement mieux que les autres alternatives m\u00e9dicamenteuses (dont Rituximab) si on veut \u00e9viter la spl\u00e9nectomie :<\/p>\n<ul>\n<li>Deux fois plus de r\u00e9ponses que sous les autres traitements : Plaquettes &gt; 50 000\/mm3\u00a0 (71%-92%) vs (26%-51%)<\/li>\n<li>Risque d&rsquo;\u00e9chec du traitement moindre (11% vs 30%)<\/li>\n<\/ul>\n<p>Au niveau effets ind\u00e9sirables, on retrouve les c\u00e9phal\u00e9es et la fatigue ainsi que des \u00e9v\u00e9nements thrombotiques (non retrouv\u00e9s dans le bras \u00ab\u00a0standard\u00a0\u00bb) : 3 embolies pulmonaires et 2 TVP&#8230; A combien \u00e9taient remont\u00e9es les plaquettes ? \ud83d\ude09<br \/>\nUn seul cas de fibrose r\u00e9ticulinique a \u00e9t\u00e9 observ\u00e9 dans le bras romiplostim.<\/p>\n<p>En conclusion, difficile de conclure quand on a un bras r\u00e9f\u00e9rence aussi h\u00e9t\u00e9rog\u00e8ne et non standard. Il ne faut pas oublier non plus le co\u00fbt du traitement par romiplostim (677 euros par flacon : 1 \u00e0 3 flacon\/semaine selon la posologie) qui n&rsquo;est pas curatif et qui n\u00e9cessite un traitement hebdomadaire continu \u00e0 vie&#8230;<\/p>\n<p>PS : la lecture de l&rsquo;\u00e9dito sur le PTI est bien plus int\u00e9ressante et correspond plus \u00e0 la \u00ab\u00a0vraie vie\u00a0\u00bb&#8230;<br \/>\n<\/p>\n<div class=\"pdf24Plugin-cp\"> \t<form name=\"pdf24Form0\" method=\"post\" action=\"https:\/\/doc2pdf.pdf24.org\/wordpress.php\" target=\"pdf24PopWin\" onsubmit=\"var pdf24Win = window.open('about:blank', 'pdf24PopWin', 'resizable=yes,scrollbars=yes,width=600,height=250,left='+(screen.width\/2-300)+',top='+(screen.height\/3-125)+''); pdf24Win.focus(); if(typeof pdf24OnCreatePDF === 'function'){void(pdf24OnCreatePDF(this,pdf24Win));}\"> \t\t<input type=\"hidden\" name=\"blogCharset\" value=\"Cw1x07UAAA==\" \/><input type=\"hidden\" name=\"blogPosts\" value=\"MwQA\" \/><input type=\"hidden\" name=\"blogUrl\" value=\"yygpKbDS1y8vL9cryMrQSyvSL88vSikoSi0uBgA=\" \/><input type=\"hidden\" name=\"blogName\" value=\"C0gtKs7PS8xR8MovLQLR+WkKjgoeiam5iSX5OfnpmcUlAA==\" \/><input type=\"hidden\" name=\"blogValueEncoding\" value=\"gzdeflate base64\" \/><input type=\"hidden\" name=\"postId_0\" value=\"M7O0AAA=\" \/><input type=\"hidden\" name=\"postTitle_0\" value=\"C8rPzSzIyS8uycxVyC9VOLT60ILiksS8lMSiFIXkxKLUQwsO7VZIScwrVshJVQgI8VRTtjAyNrBWcFYrKi4szbdOLS5RANKZIGkUjQr2AA==\" \/><input type=\"hidden\" name=\"postLink_0\" value=\"yygpKbDS1y8vL9cryMrQSyvSL88vSikoSi0u1rcvsDWztAAA\" \/><input type=\"hidden\" name=\"postAuthor_0\" value=\"cylSCMhMzgcA\" \/><input type=\"hidden\" name=\"postDateTime_0\" value=\"MzIwNNA1NNQ1NFUwNLcyNLQyNQIA\" \/><input type=\"hidden\" name=\"postContent_0\" value=\"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\" \/> \t\t<a href=\"https:\/\/www.pdf24.org\" target=\"_blank\" title=\"www.pdf24.org\" rel=\"nofollow\"><img src=\"http:\/\/www.pjh.fr\/wordpress\/wp-content\/plugins\/pdf24-post-to-pdf\/img\/pdf_32x32.png\" alt=\"\" border=\"0\" height=\"32\" \/><\/a> \t\t<span class=\"pdf24Plugin-cp-space\">&nbsp;&nbsp;<\/span> \t\t<span class=\"pdf24Plugin-cp-text\">Envoyer l'article en PDF<\/span> \t\t<span class=\"pdf24Plugin-cp-space\">&nbsp;&nbsp;<\/span> \t\t<input class=\"pdf24Plugin-cp-input\" style=\"margin: 0px;\" type=\"text\" name=\"sendEmailTo\" placeholder=\"Entrez l'adresse e-mail\" \/> \t\t<input class=\"pdf24Plugin-cp-submit\" style=\"margin: 0px;\" type=\"submit\" value=\"Envoyer\" \/> \t<\/form> <\/div>","protected":false},"excerpt":{"rendered":"<p>Un article publi\u00e9 dans le NEJM du 11 Novembre \u00ab\u00a0compare\u00a0\u00bb l&#8217;emploi de la ROMIPLOSTIM (agoniste de la thrombopo\u00ef\u00e9tine) au \u00ab\u00a0standard of care\u00a0\u00bb du PTI&#8230; D\u00e9j\u00e0 au titre \u00e7a commence mal : what is the standard of care of TPI ? En r\u00e9sum\u00e9 : 234 patients avec un PTI n&rsquo;ayant pas \u00e9t\u00e9 spl\u00e9nectomis\u00e9 ayant re\u00e7u au [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":703,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[87],"tags":[70,71],"_links":{"self":[{"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=\/wp\/v2\/posts\/698"}],"collection":[{"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=698"}],"version-history":[{"count":7,"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=\/wp\/v2\/posts\/698\/revisions"}],"predecessor-version":[{"id":776,"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=\/wp\/v2\/posts\/698\/revisions\/776"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=\/wp\/v2\/media\/703"}],"wp:attachment":[{"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=698"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=698"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.pjh.fr\/wordpress\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=698"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}