ALBERT

Description: Treatment strategies for immune thrombocytopenia (ITP) aim to achieve a platelet count associated with adequate hemostasis while maximizing patient (pt) quality of life (QoL) and minimizing treatment-emergent toxicities. However, physicians' (MDs) and pts' treatment goals have not been studied and compared. I-WISh is a cross-sectional survey of 1507 ITP pts and 472 MDs across 13 countries studying burden of ITP and pt QoL using a global pt and MD sampling frame; pts were recruited via MDs and pt advocacy groups (PAGs). ITP expert MDs and PAG representatives designed and endorsed the survey. We report treatment goals that MDs and pts perceive as being most important and how these vary among countries and different healthcare systems. Pt-reported use of ITP treatments at time of survey and any prior time are also described. Top-ranked treatment goals for MDs were reduction in spontaneous bleeds (72%), better QoL (64%), and healthy blood counts (51%). The top treatment goals for pts were healthy blood counts (64%), preventing episodes of ITP worsening (44%), and increasing energy levels (41%). More MDs than pts selected reduction in spontaneous bleeds (72% vs 38%) and QoL (64% vs 38%) as top priorities; fewer MDs vs pts selected healthy blood counts (51% vs 64%) and reduction of fatigue (15% vs 41%). MD and pt rankings of their top 3 treatment goals by country are shown in Fig.1 A&B and differences in MD vs pt perceptions in Fig. 1C. The largest differences in the percentage of MDs and pts who ranked reduction in spontaneous bleeds as a top goal were observed in France, India, Canada, UK, and USA; in each country, MDs ranked this treatment goal more often in their top 3 than pts. In contrast, lighter menstrual periods had a 〈 10% difference between pts and MDs in all but 2/13 countries. In certain countries, responses appeared to be balanced across similar goals, i.e. ~40% difference in ranking of reduction in spontaneous bleeds by MDs vs pts and healthy blood counts by pts vs MDs in the UK. Similarly, an 11% difference in MD vs pt ranking of improved QoL and pt vs MD ranking of increasing energy levels were observed. The largest differences in the percentages of MDs and pts who ranked healthy blood counts in their top 3 goals were observed in UK and Colombia. The largest differences between MDs and pts in their perception of reduction of fatigue as a top 3 goal were in Canada, Egypt, USA, and UK; MDs generally ranked it less important than pts, except in India. Corticosteroids (CSs) were prescribed in 79% of pts for treatment of ITP, with 26% of pts on CSs at time of survey. Countries with the highest CS use at any time were Colombia, France, and USA; Colombia, India, and Egypt had the highest CS use at time of survey. Lowest CS use at any time prior to the survey was reported by pts in Japan, Turkey, and Germany. Thrombopoietin receptor-agonists (TPO-RAs) were prescribed in 27% of pts, with 17% of pts on TPO-RA at time of survey. Countries with highest TPO-RA use at any time were Turkey, UK, Egypt, and USA. At the time of survey, TPO-RAs were most frequently used by pts in Egypt, with the lowest use in Japan. Anti-CD20 was prescribed in 29% of pts, with 5% on anti-CD20 at the time of survey. Countries with highest anti-CD20 use at any time were USA, France, and Canada. At the time of survey, anti-CD20s were most frequently used by pts in India, with no use in Turkey or Egypt. CSs were the most prevalent ITP treatments prior to and at time of survey. While this was to be expected, the high use of steroids in the USA and France compared with other countries was unanticipated. TPO-RAs and anti-CD20 have changed the landscape of second-line ITP therapies, but their utilization varies greatly among countries. Access to advanced/costly therapies is one factor that differs between countries and may influence treatment trends, but others are also important. The I-WISh survey showed that certain specific treatment goals are perceived differently by MDs and pts. Interpretation of the data is limited by the similarity of answer choice (eg, healthy blood counts and absence of spontaneous bleeds; fatigue, a key component of QoL; and QoL), which may have led to differences in responses despite similar understanding. Nonetheless, an overall agreement was generally observed, which may have been facilitated by increased MD and pt access to information through the internet and other sources, eg, medical education activities. Figure 1 Disclosures Bussel: Tranquil: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; argenx: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Kezar Life Sciences: Consultancy, Membership on an entity's Board of Directors or advisory committees; UCB: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; RallyBio: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Physician Education Resource: Speakers Bureau; 3S Bio: Speakers Bureau; Rigel: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; GSK: Honoraria, Membership on an entity's Board of Directors or advisory committees; Dova Pharmaceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Momenta Pharmaceuticals: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Regeneron: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Ghanima:Amgen: Consultancy, Honoraria; Bayer: Honoraria, Research Funding; Pfizer/BMS: Research Funding; Novartis: Consultancy, Honoraria, Research Funding. Tomiyama:Chugai: Honoraria; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Kyowa-Kirin: Honoraria. Arnold:Rigel: Consultancy, Research Funding; Novartis: Honoraria, Research Funding; Bristol-Myers Squibb: Research Funding; Principia: Consultancy. Provan:Rigel ONO: Consultancy, Research Funding; ONO Pharmaceutical: Consultancy; Amgen: Consultancy, Honoraria, Research Funding; MedImunne: Consultancy; UCB: Consultancy; Novartis: Consultancy, Honoraria, Research Funding. Santoro:Grifols: Membership on an entity's Board of Directors or advisory committees; Novo Nordisk: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Shire: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; CSL: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Sobi: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Amgen: Speakers Bureau; GSK: Speakers Bureau; Bayer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Pfizer: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Gilead: Membership on an entity's Board of Directors or advisory committees. Kruse:UCB: Honoraria; Amgen: Research Funding; Argenx: Research Funding; Dova: Research Funding; Novartis: Research Funding; Momenta: Research Funding; Principia: Research Funding; Octapharma: Research Funding; CSL Behring: Research Funding; UCB: Research Funding; Novartis: Consultancy. Waller:Adelphi Real World: Employment; Novartis: Consultancy. Haenig:Novartis: Employment. Cooper:Principia: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Rigel: Consultancy, Membership on an entity's Board of Directors or advisory committees.

Description: Background: ITP has a multifaceted impact on patients' (pts) lives but there are limited data on which signs and symptoms treating physicians (MDs) and pts perceive as having the greatest impact, especially on pt quality of life (QoL). As in many chronic autoimmune diseases, fatigue can significantly affect QoL in ITP pts. Aims: I-WISh studied the burden of ITP and its impact on QoL, especially fatigue, using a global pt and MD sampling frame. This analysis reports pt vs MD perception of frequency and severity of signs and symptoms. Methods : I-WISh is a cross-sectional survey of ITP pts, recruited via MDs and pt support groups, and also of MDs, recruited via local fieldwork agencies. Participants (pts and MDs) completed a 30-minute online survey that included demographics, signs and symptoms, impact of symptoms, and pt-MD relationships. A steering committee of expert MDs and pt advocacy ITP specialists designed and endorsed survey materials. Results: 1491 pts from 12 countries completed the survey; 65% female, with a mean (SD) age of 47 (16) yrs. 472 MDs from 13 countries completed the survey, with a mean (SD) ITP pt caseload of 34 (50) and a mean (SD) of 18 (36) newly-diagnosed pts in the past yr. The most frequent pt-reported signs and symptoms at diagnosis and at survey completion (Figure A,B) were petechiae (65%; 31%), bruising (64%; 30%), fatigue (58%; 50%), and anxiety around a stable platelet count (34%; 32%). The most common signs and symptoms MDs reported at diagnosis and overall (ie at any stage) were similar to those reported by pts, with petechiae (82% overall; 83% at diagnosis), purpura (74%; 73%), bleeding of the gums (69%; 70%), and epistaxis (69%; 70%) being the most common; there were few differences between diagnosis and overall. By contrast, fatigue was under-reported by MDs (31% overall; 30% at diagnosis) compared with pt-reported data (58% diagnosis; 50% survey completion). Pts rated the severity of their current symptoms. Fatigue was one of the most severe pt-reported symptoms, ie scored ≥5 on a 7-point Likert scale (7=worst imaginable severity), both at diagnosis (74%) and survey completion (65%), and remained consistently frequent and severe over time (Figure A,B). Of pts experiencing heavy menstrual bleeding (84%; 63%) and anxiety around a stable platelet count (78%; 65%) these were also reported as severe, although less so at survey completion. Thrombosis, while not common, was considered severe (62%; 74%; Figure A,B). When asked to consider their current symptoms, the three symptoms pts would most like to resolve were heavy menstrual bleeding (75%, n=118/158), thrombosis (74%, n=25/34), and fatigue (73%, n=544/743). MDs perceived several signs and symptoms as having a high impact on pt QoL (scored ≥5 on a 7-point Likert scale; 7=a great deal), with blood in urine/stool (81%), profuse bleeding during surgery (79%), and menorrhagia (78%) considered the most impactful; 59% believed fatigue has a high impact. Overall, 80% of MDs felt ITP symptoms reduce QoL (scored ≥5 on a 7-point Likert scale; 7=a great deal), and 66% believed that ITP-related fatigue reduces QoL. 46% of MDs believe fatigue is severe (scored ≥5 on a 7-point Likert scale; 7=completely fatigued) and believe fatigue increases as platelet levels decrease (Figure C). Pts are generally satisfied (79% satisfaction) with their MD's management of their disease, and overall satisfaction between pts and MDs was high regarding communication (80% vs 88%), management (79% vs 86%), and understanding of treatment goals (77% vs 90%). Summary/conclusions: The pt-reported symptom with highest frequency and greatest severity both at diagnosis and survey completion was fatigue. MDs who participated were experienced with treating ITP and believed fatigue would greatly affect pts, nonetheless MDs did not consider fatigue to be as substantial a problem as pts did. Pts were also concerned about platelet count stability, heavy menstrual bleeding, and thrombosis. Likelihood of fatigue increased as platelet count reduced suggesting fatigue may be intrinsically related to disease activity and could be alleviated by increasing the platelet count. These results indicate that pts and MDs align on overall symptom burden in ITP but highlight that improved understanding and awareness of the relationships between fatigue, platelet count, and QoL is needed. Disclosures Kruse: Novartis/ITP: Consultancy; Rigel/ITP: Honoraria; Amgen/ITP: Consultancy. Watson:Novartis: Membership on an entity's Board of Directors or advisory committees. Cooper:Amgen, Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Ghanima:Amgen, Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bayer, BMS, Novartis: Research Funding. Provan:Amgen, Novartis: Honoraria, Research Funding. Arnold:Amgen: Consultancy, Research Funding; UCB: Consultancy; Bristol Myers Squibb: Research Funding; UCB: Consultancy; Amgen: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Bristol Myers Squibb: Research Funding; Novartis: Consultancy, Research Funding. Santoro:Bayer, CSL, Novo Nordisk, Pfizer, Shire, Sobi: Other: advisory boards, Speakers Bureau; Grifols, Gilead: Other: advisory boards; Amgen, Glaxo: Speakers Bureau. Tomiyama:Sysmex Corporation: Consultancy; Chugai Pharmaceutical Co., Ltd.: Honoraria; Novartis Pharma Co., Ltd.: Honoraria, Membership on an entity's Board of Directors or advisory committees; Kyowa Hakko Kirin Co., Ltd.: Honoraria. Waller:Novartis: Consultancy. Taylor-Stokes:Novartis: Consultancy. Bailey:Novartis: Consultancy. Stankovic:Novartis: Employment. Bussel:Novartis: Consultancy, Research Funding; Uptodate: Honoraria; Rigel: Consultancy, Research Funding; Momenta: Consultancy; Protalex: Consultancy; Amgen Inc.: Consultancy, Research Funding; Prophylix: Consultancy, Research Funding.

Description: Background: The impact of ITP on patient (pt) QoL is multidimensional, broadly encompassing daily activities, emotional health, and work life. Health-related QoL has been shown to be substantially reduced in ITP pts relative to healthy controls, yet the full impact of ITP on affected pts is not well-defined. Aims: I-WISh studied the burden of ITP and its impact on QoL using a global pt and physician (MD) sampling frame. This analysis reports the impact of ITP on QoL, emotional health, and work productivity, and evaluates similarities and differences between pt and MD viewpoints. Methods : I-WISh is a cross-sectional survey of ITP pts, recruited via MDs and pt support groups, and MDs recruited via local fieldwork agencies. Participants (pts and MDs) completed a 30-minute online survey that included demographics and the impact of ITP on QoL, emotional health, work productivity, and need for caregivers. A steering committee of expert MD and pt advocacy leads specializing in ITP designed and endorsed survey materials. Results: 1491 pts from 12 countries completed the survey; 65% were female, mean (SD) age was 47 (16) years. 472 MDs from 13 countries completed the survey; 56% were university or teaching hospital based, with a mean (SD) ITP pt caseload of 34 (50) and a mean (SD) of 18 (36) newly-diagnosed pts in the past year. Overall, 84% (n=1258/1489) of pts reported that ITP reduced their energy levels, 77% (n=1149/1489) said ITP reduced their capacity to exercise, 75% (n=1116/1489) said ITP limited their ability to perform daily tasks, and 70% (n=1035/1485) said ITP impaired their social life. The proportion of pts reporting an impact of ITP on their QoL increased with symptom burden (Figure A); 98% of pts (n=298/303) with the greatest symptom burden reported an impact on energy levels and 〉90% reported an impact of ITP for 6/10 questions. MDs perceived potential bleeding as having the greatest impact on pt QoL (scored ≥5 on a 7-point Likert scale, where 7=great deal), with 88%, 73%, and 69% perceiving concerns of increased bleeding risk during sport, travel, and sex, respectively, as areas in which pt QoL could be affected. Fewer MDs than pts felt that ITP would greatly impact daily activities (52% vs 75%) or family and social life (45% vs 70%). 82% of MDs indicated they either do or would use a pt QoL tool at least every 6 months to monitor pts. Almost half (49%; n=731) of all pts stated ITP had a high impact on their emotional well-being (score ≥5 on 7-point Likert scale, where 7=great deal), with 63% (n=944) worried their condition would worsen. More pts with very high symptom burden reported high emotional impact (75%; n=227/303), with 85% (n=259/303) worrying about their condition worsening. MDs gave similar results to pts for emotional impact and considered anxiety about platelet counts the primary cause (85%). Nearly half of pts who worked (43%; n=383/894) reported that ITP affects their work productivity (score ≥4 on a 10-point scale, where 10=completely prevented from working), with 24% (n=212/889) having missed ≥6 hours' work in the week prior to survey completion. 48% (n=715/1491) of all pts had either reduced or seriously considered reducing their hours at work, and 21% (n=306/1491) had considered terminating their employment because of ITP (Figure B). Despite this, 62% (n=554/888) work 〉30 hours/week. Pts with very high symptom burden (n=303) reported greater impact on their work, with 69% either having reduced or seriously considering reducing their hours and 43% having considered terminating employment. Over half of pts (52%) reported needing care assistance, with their spouse being the main caregiver (59%; n=461/775), requiring an average of 16.3 hours of support in a week. Caregivers provided companionship (69%; n=534/775), helped with household chores (55%; n=429/775), and aided transportation (50%; n=386/775). Summary/conclusions: I-WISh demonstrates that most ITP pts experience substantially impaired QoL, with daily activities, social interactions, emotional well-being, and working lives all affected. Pts frequently report severe fatigue and pts with high ITP symptom burden were particularly affected, with nearly all pts reporting substantially reduced energy levels. Pts also worried about their condition worsening and had reduced work capacity. These results highlight the need for MDs to consider the impact of ITP disease burden on all aspects of individual pts' lives during management of ITP. Disclosures Cooper: Amgen, Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Kruse:Novartis/ITP: Consultancy; Rigel/ITP: Honoraria; Amgen/ITP: Consultancy. Watson:Novartis: Membership on an entity's Board of Directors or advisory committees. Bussel:Rigel: Consultancy, Research Funding; Protalex: Consultancy; Momenta: Consultancy; Prophylix: Consultancy, Research Funding; Amgen Inc.: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Uptodate: Honoraria. Ghanima:Amgen, Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Bayer, BMS, Novartis: Research Funding. Arnold:Novartis: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; UCB: Consultancy; Bristol Myers Squibb: Research Funding; Amgen: Consultancy, Research Funding; UCB: Consultancy; Amgen: Consultancy, Research Funding; Bristol Myers Squibb: Research Funding. Santoro:Bayer, CSL, Novo Nordisk, Pfizer, Shire, Sobi: Other: advisory boards, Speakers Bureau; Grifols, Gilead: Other: advisory boards; Amgen, Glaxo: Speakers Bureau. Tomiyama:Sysmex Corporation: Consultancy; Kyowa Hakko Kirin Co., Ltd.: Honoraria; Novartis Pharma Co., Ltd.: Honoraria, Membership on an entity's Board of Directors or advisory committees; Chugai Pharmaceutical Co., Ltd.: Honoraria. Waller:Novartis: Consultancy. Bailey:Novartis: Consultancy. Taylor-Stokes:Novartis: Consultancy. Stankovic:Novartis: Employment. Provan:Amgen, Novartis: Honoraria, Research Funding.

Description: Immune thrombocytopenia (ITP) is an acquired autoimmune disorder defined by a platelet count 〈 100 × 109/L without explanation, and an increased risk of bleeding. ITP itself as well as its treatments have multifaceted, often poorly understood impacts on patients' quality of life (QoL). These effects include impact on activities of daily living, emotional health, energy, ability to think well and clearly, and productivity in the workplace. There are limited data on which individual aspects of ITP are perceived both by patients and physicians as having the greatest impact on QoL. Understanding patients' perspectives is vital to optimize their QoL by specifying particular areas in need of therapy. I-WISh 1.0 was an exploratory, cross-sectional survey in which 1507 patients with ITP and 472 physicians across 13 countries completed separate, but related, online surveys that included assessments of ITP signs and symptoms, impact of symptoms, and patient-physician relationships. These findings have been presented at previous ASH and EHA congresses, and manuscripts are currently in preparation. However, although I-WISh 1.0 provided considerable insights into unexplored facets of the effects of ITP, an all-too-large number of gaps in understanding still remain. In response to this, I-WISh 2.0 is currently being developed. The objectives of the I-WISh 2.0 patient and physician cross-sectional surveys include: (1) to further explore the burden of fatigue and how it affects patients' lives, including what makes it better or worse; (2) to assess the emotional impact of living with chronic ITP, especially in relation to depression; (3) to assess how treatments for ITP can impact activities of daily living (positively and negatively); (4) to further relate effects of treatment to patients' QoL; and (5) to explore how telemedicine affects healthcare delivery for patients with ITP. Furthermore, data from subsets of patients will address (6) the impact of COVID-19 in patients with ITP; and (7) special issues affecting ITP in pregnancy. A steering committee of ITP expert physicians and patient advocacy group representatives are designing and will endorse the patient and physician surveys now nearing readiness after several meetings to determine the areas of greatest need of assessment. In addition, a control group will be included. Survey launch and data collection are scheduled to commence in early Q4 2020. Patients and physicians will complete similar online surveys. Both patient and physician surveys include a screener and sections of questions related to the specific objectives of I-WISh 2.0. The surveys include updates to key topics in I-WISh 1.0 (impact of fatigue, impact on daily life, treatment of ITP, emotional impact of ITP); validated patient-reported outcome tools to measure fatigue (MFIS-5), presence and severity of depression (PHQ-9), work-related burden (WPAI), and impact on quality of life (ILQI) tools; and questions related to COVID-19, telemedicine (remote patient monitoring), and pregnancy and ITP. Patients will be recruited to I-WISh 2.0 via treating physicians and patient advocacy groups, and will be included if they are ≥ 18 years of age, diagnosed with ITP, and agree to participate. Participating physicians will be required to be actively managing patients with ITP and have a minimum caseload of 3 ITP patients currently under their care; physicians must also have a primary specialty of hematology or hematology-oncology. Approval will be sought from an independent centralized Institutional Review Board. Data analysis will be primarily descriptive and correlative in nature. Breakdown by country and geographic areas will be included. A global sample is planned from 21 countries across 6 continents, with the aim of surveying more than 2000 patients and 600 physicians. I-WISh 2.0 will be the largest observational global survey ever conducted in ITP. If accepted, preliminary data are planned to be presented at the ASH meeting. I-WISh 2.0 will build on the strengths of I-WISh 1.0, which highlighted areas requiring further assessment and will explore aspects of ITP of great interest that were neither conclusively addressed in the first survey nor well-studied in the past. Disclosures Ghanima: Bristol Myers Squibb:Research Funding;Principia:Honoraria, Speakers Bureau;Pfizer:Honoraria, Research Funding, Speakers Bureau;Amgen:Honoraria, Speakers Bureau;Novartis:Honoraria, Speakers Bureau;Bayer:Research Funding.Provan:ONO Pharmaceutical:Consultancy;MedImmune:Consultancy;UCB:Consultancy;Amgen:Honoraria, Research Funding;Novartis:Honoraria, Research Funding.Cooper:Amgen:Honoraria, Speakers Bureau;Novartis:Honoraria, Speakers Bureau.Matzdorff:Roche Pharma AG:Other: Family stockownership;Amgen GmbH:Consultancy, Other: Honoraria paid to institution;Grifols Deutschland GmbH:Consultancy, Other: Honoraria paid to institution;Swedish Orphan Biovitrium GmbH:Consultancy, Other: Honoraria paid to institution;UCB Biopharma SRL:Consultancy, Other: Honoraria paid to institution;Novartis Oncology:Consultancy, Other: Honoraria paid to institution.Santoro:Novartis:Honoraria, Speakers Bureau;Takeda:Honoraria, Speakers Bureau;Amgen:Honoraria, Speakers Bureau;Novo Nordisk:Honoraria, Speakers Bureau;Bayer:Honoraria, Speakers Bureau;CSL Behring:Honoraria, Speakers Bureau;Roche:Honoraria, Speakers Bureau;Sobi:Honoraria, Speakers Bureau.Morgan:Sobi:Other: Consultancy fees paid to the ITP Support Association;UCB:Other: Consultancy fees paid to the ITP Support Association;Novartis:Other: Consultancy fees paid to the ITP Support Association.Kruse:Principia:Other: Grant paid to PDSA;Pfizer:Other: Grant and consultancy fee, all paid to PDSA;Argenx:Other: Grant paid to PDSA;Novartis:Other: PDSA received payment for recruiting patients to I-WISh and for promoting I-WISh on the globalitp.org website. Grant and consultancy fee, all paid to PDSA outside the submitted work;CSL Behring:Other: Grant paid to PDSA;UCB:Other: Grant and consultancy fee, all paid to PDSA;Rigel:Other: Grant paid to PDSA;Amgen:Other: Grant and honorarium, all paid to PDSA.Zaja:Janssen-Cilag:Honoraria, Speakers Bureau;Takeda:Honoraria, Speakers Bureau;Bristol Myers Squibb:Honoraria, Speakers Bureau;Grifols:Honoraria, Speakers Bureau;Amgen:Honoraria, Speakers Bureau;AbbVie:Honoraria, Speakers Bureau;Kyowa Kirin:Honoraria, Speakers Bureau;Mundipharma:Honoraria, Speakers Bureau;Novartis:Honoraria, Patents & Royalties: Pending patent (No. PAT058521) relating to TAPER trial (NCT03524612), Speakers Bureau;Roche:Honoraria, Speakers Bureau.Lahav:Novartis:Other: Consultancy fees paid to the Israeli ITP Support Association.Tomiyama:Novartis:Consultancy, Honoraria;Kyowa Kirin:Honoraria;Sysmex:Consultancy.Winograd:Novartis:Other: Consultancy fees paid to the Israeli ITP Support Association.Lovrencic:UCB:Other: Consultancy fees paid to AIPIT;Novartis:Other: Honorarium paid to AIPIT.Bailey:Adelphi Real World:Current Employment;Novartis:Other: Employee of Adelphi Real World, which has received consultancy fees from Novartis.Haenig:Novartis:Current Employment.Bussel:Novartis:Consultancy;Argenx:Consultancy;UCB:Consultancy;CSL Behring:Consultancy;Shionogi:Consultancy;Regeneron:Consultancy;3SBios:Consultancy;Dova:Consultancy;Principia:Consultancy;Rigel:Consultancy;Momenta:Consultancy;RallyBio:Consultancy;Amgen:Consultancy.