Commentary
Video
Highlighting the Danger of SCI Progression during iTTP Remission, with Shruti Chaturvedi, MBSS, MS
Author(s):
Chaturvedi discussed findings from the NeST study at ASH 2024, including an increased risk of stroke in those with silent cerebral infarction progression.
Silent cerebral infarctions (SCI) are progressive even during remission in immune thrombotic thrombocytopenic purpura (iTTP) without acute episodes. SCI progression should be prevented in these patients to reduce stroke risk and may be a suitable endpoint in intervention trials aiming to mitigate adverse neurovascular outcomes in iTTP.
These findings are from the prospective NeST study, data from which were presented at the 66th American Society of Hematology (ASH) Annual Meeting and Exposition, held December 7-10, 2024, in San Diego, California, by Shruti Chaturvedi, MBBS, MS, Associate Professor of Medicine at Johns Hopkins Medicine.
“These ischemic lesions, or vascular disease, in the brain is progressing during remission. So, we should treat all of our TTP patients as the kind of patients that you would consider high risk for stroke. So intensive risk factor modification. If they have high blood pressure, we need to control it. We need to make sure that their cholesterol is under control. If they have diabetes, if they're smoking, all of that needs to be addressed until we have more targeted interventions for this population,” Chaturvedi advised clinicians during a conversation with HCPLive® during the ASH meeting.
Chaturvedi and colleagues found that of 26 participants with repeat imaging, new or progressive lesions were seen in 38.5% (n = 10) The median Age-Related White Matter Changes score also significantly increased from 2 to 2.5 (P = .002) on the follow up MRI. Notably, the rate of stroke was significantly higher in those with progressive SCI than those without progressive SCI (30% vs. 0%, P = .020).
“This data actually highlights that SCI and its progression, which you can monitor for even as short as 1 year, might be a reasonable end point for these trials, thereby reducing the cost and duration of trials in an ultra-rare disease,” Chaturvedi said.
