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wAIHA | Fostamatinib May Induce Durable Hemoglobin Response in Subset of Patients

In a recent study published in the American Journal of Hematology, it was discovered that fostamatinib, a promising treatment for warm antibody autoimmune hemolytic anemia (wAIHA), has the potential to trigger a long-lasting increase in haemoglobin levels for some patients.

Interestingly, this positive outcome was predominantly observed among participants hailing from North America, Australia, or Western Europe, while those from Eastern Europe didn’t show the same results.

The current treatment landscape for wAIHA consists of a mixture of therapies like corticosteroids and rituximab; however, there’s still a lack of disease-specific treatments. The approval of fostamatinib—a spleen tyrosine kinase inhibitor—in the United States for treating patients with chronic immune thrombocytopenia brings hope for advancements in wAIHA treatment options.

For this randomized phase 3 study (ClinicalTrials.gov Identifier: NCT03764618), researchers evaluated whether fostamatinib is superior to placebo for achieving a durable haemoglobin response among patients with wAIHA who have had an insufficient response to at least 1 prior therapy line.

In this study, 90 participants were divided equally between the fostamatinib and placebo groups. Interestingly, 53 patients hailed from North America, Australia, or Western Europe, while the remaining 37 came from Eastern Europe. The median baseline haemoglobin levels for the fostamatinib and placebo groups were 8.4 and 8.9 g/dL, respectively.

While the analysis revealed no significant difference in durable haemoglobin response rates between the two groups (35.6% for fostamatinib and 26.7% for placebo; P =.398), a post-hoc analysis indicated that a high placebo response rate among Eastern European patients might have influenced this result.

For those patients coming from North America, Australia, or Western Europe, the haemoglobin response rate was favorably higher in the treatment group as opposed to placebo (36% vs 10.7%, respectively; P =.03).

Moreover, an intriguing follow-up analysis that excluded haemoglobin values impacted by steroid rescue during screening – as well as two patients in the placebo group who likely did not have wAIHA – showed an apparent increase in durable haemoglobin response rates within the fostamatinib group (33.3% vs 14% with placebo; P = .0395).

Regarding adverse events, 93.3% of patients in the fostamatinib group experienced at least one, compared to 88.9% in the placebo group. Some of the most common events included diarrhea (26.7%), hypertension (24.4%), and fatigue (15.6%).

Ultimately, the authors concluded that fostamatinib could potentially serve as an effective treatment option for patients with wAIHA – quite a noteworthy discovery!

Source: Haematology Advisor – https://onlinelibrary.wiley.com/doi/10.1002/ajh.27144

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