Supplementary MaterialsESM 1: (DOCX 1192 kb) 277_2020_4173_MOESM1_ESM. started. Primary strategies applied as first-line therapy consisted of steroids in 45% and a watch and wait approach in 41% of individuals. During second- and third-line strategies, treatment with steroids decreased (36% and 28%, respectively), while treatment modalities such as TPO-RAs improved (19% and 26%, respectively). As expected, individuals with a low platelet count and thus a higher risk for bleeding and mortality received treatment (esp. steroids) more frequently during 1st line than those with a higher platelet count. Up to a third of individuals were treated with steroids for more than a 12 months. Overall, our study provides a cross-section overview about the current therapeutic P4HB treatment scenery in German ITP individuals. The results will help to improve restorative management of ITP individuals. Electronic supplementary material The online version of this article (10.1007/s00277-020-04173-5) contains supplementary material, which is available to authorized users. (%)??Woman541 (52.9)??Man481 (47.1)Age group, (%)??0C60 (0)??7C174 (0.4)??18C30104 (10.,2)??31C50174 (17.0)??51C60171 (16.7)?? ?60570 (55.7)ITP classification, (%)??Primary735 (72.1)??Secondary150 (14.7)??Not really classified134 (13.2)ITP stage, (%)??Diagnosed48 (5 Newly.1)??Persistent154 (16.2)??Chronic748 (78.7)Disease 7-Methoxyisoflavone manifestation at medical diagnosis, (%)??0C10123 (12.0)??11C30192 (18.8)??31C50211 (20.7)??51C100495 (48.5)Bone marrow biopsy??Yes511 (50.0)??Zero492 (48.2)??Unknown18 (1.8) Open up in another screen aMultiple answers allowed (in cases like this, equals the amount of answers given rather than variety of sufferers) Disease manifestation in medical diagnosis according to platelet count The symptoms occurring at analysis of ITP differed between the groups. In individuals with 7-Methoxyisoflavone the lowest platelet count (0C10??109/l), the event of petechiae and hematomas was the main reasons for analysis of ITP (52%; Fig. ?Fig.1a).1a). This was similar for individuals having a platelet count of 11C30??109/l (53%). While those two disease manifestations were regularly present at analysis of ITP in individuals having a platelet count of 31C50??109/l (35%), in the same percentage of individuals, the analysis was due to an incidental getting (35%). This percentage improved in individuals having a platelet count of 51C100??109/l, with as many as 62% of diagnoses being made due to incidental findings (Fig. ?(Fig.1b).1b). For numbers of individuals having a platelet count of 11C30 as well as 31C50??109/l, observe supplemental number 2. Open in a separate windowpane Fig. 1 Disease manifestation at analysis relating to platelet count at analysis in individuals with platelet count of a 0C10 or b 51C100. Multiple answers allowed (in this case, equals the number of answers given and not quantity of individuals; percentages indicate main answer given and not the proportion of individuals) Restorative strategies The main strategies applied as first-line therapy consisted of steroids in 45% and a watch and wait approach in 41% of individuals, followed by IVIG in 7% and platelet concentrates in 3%. Second-line therapy consisted of steroids in 36%, TPO-RAs in 19%, IVIG in 18%, watch and wait in 14%, rituximab in 5%, splenectomy in 3%, as well as platelet concentrates, chemotherapy, while others in 7-Methoxyisoflavone 2% each. Third-line therapy consisted of steroids in 28%, TPO-RAs in 26%, watch and wait in 13%, IVIG in 11%, rituximab in 7%, splenectomy as well as platelet concentrates in 4% each, chemotherapy in 1%, and additional restorative strategies in 6%. At the time of the survey, 62% of evaluated individuals were free of therapy. Treatment decision based on platelet count Restorative strategies differed according to the individuals platelet count at analysis. In individuals having a platelet count of 0C10??109/l, the main strategy applied while first-line therapy were steroids (68%) followed by IVIG (16%) and platelet concentrates (7%), see Fig. ?Fig.2a2a (left panel). During second- and third-line treatment, respectively, IVIG (21% and 15%), TPO-RAs (21% and 32%), and also rituximab (6% and 10%; off-label) were increasingly used; however, steroids (39% and 30%) were still one of the main treatment modalities (Fig. 2b and c; left panel). Open in a separate windowpane Fig. 2 Treatment strategies relating to platelet count during a 1st-, b second-, and c third-line treatment. Multiple answers allowed (in this case, equals the number of answers given rather than variety of sufferers; percentages indicate primary answer provided rather than the percentage of sufferers receiving treatment) An identical treatment design was seen in sufferers using a platelet count number of 11C30??109/l, where steroids were also the mostly utilized first-line strategy (68%) and the usage of TPO-RAs increased with additional treatment lines (initial series: 2%, second series: 21%, third series: 29%; find supplement material amount.