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The project proposes to facilitate the design and evaluation of interventions based on mobile technologies and information systems in order to improve the capacity for self-management, empowerment and control of chronic and multimorbidity patients. The system allows to create customizable apps according to the needs of primary care and specialized care. The project includes an evaluation of the impact of the care model, as well as the effectiveness and efficiency of the intervention through a study with 124 multimorbidity patients.

The project proposes to facilitate the design and evaluation of interventions based on mobile technologies and information systems in order to improve the capacity for self-management, empowerment and control of chronic and multimorbidity patients. The system allows to create customizable apps according to the needs of primary care and specialized care. The project includes an evaluation of the impact of the care model, as well as the effectiveness and efficiency of the intervention through a study with 124 multimorbidity patients.

Abstract 3343 Background Anti-Rh(D) is an immune globulin against the Rh group and is used for the treatment of immune thrombocytopenia (ITP). A 75 μcg/kg dose induces an overnight response in 92% of patients and a median response duration of 46 days. More than 50% of patients treated intermittently with anti-Rh(D) continue to require therapy after one year. Danazol, an attenuated androgen, has a longer onset of action (median 3.1 months), but has steroid-sparing activity in ITP. We conducted a phase II study to determine whether danazol could lower the requirement for recurrent use of anti-Rh(D). Methods Twenty-six patients with ITP were enrolled. Treatment consisted of daily danazol 600 mg PO in combination with anti-Rh(D) 75 μg/kg IV on day 1, repeated whenever the platelet count (PLT) fell below 30,000/μL. After 1 year, danazol was reduced to 400 mg daily for 3 months then to 200 mg daily for 9 months. Chi-square analysis was used to compare requirement for just a single infusion of anti-Rh(D) with that in historical controls treated with anti-Rh(D) alone. The student t-test was used to compare rate of anti-Rh(D) usage over time in both groups. Results were analyzed by intent-to-treat. Results Patients' median age was 45 years (range 23–83 years). The male:female ratio was 1.9:1. Eleven (42%) were human immunodeficiency virus (HIV)-positive. Median time from diagnosis of ITP to enrollment was 10.5 months. Median PLT at enrollment was 15,000/μL. Nine (35%) of patients had received a median of one prior infusion of anti-Rh(D). Median duration of follow-up was 28.12 months. Nine (34.6%) of 26 study patients required just a single infusion of anti-Rh(D) in comparison with 1 (3.6%) of 28 control patients, p = 0.003. There was no correlation of age, sex, HIV status, and number of months from diagnosis of ITP with need for a single infusion of anti-Rh(D). At 1 year of follow-up, there was a 20% reduction in anti-Rh(D) use in comparison with historical controls: mean number of infusions per month 0.36 for study patients vs. 0.43 for controls, t = 0.9066, p > 0.05. Platelet responses in HIV-positive patients were not attributable to antiviral treatment. Study therapy was well-tolerated. Two patients stopped danazol due to intolerable adverse effects (grade III acne, grade II myalgias, grade I alopecia.) Conclusion Danazol demonstrates anti-Rh(D)-sparing activity. Greater than 1/3 of patients treated with the combination require just a single infusion of anti-Rh(D). The cost of an anti-Rh(D) infusion ($ 1500.00) is nearly one-half the cost of daily danazol for 1 year ($ 3600.00). Historical controls treated with anti-Rh(D) alone required a median of 5 infusions per year whereas patients treated with the combination in this study required a median of 2 infusions per year. This reduction in anti-Rh(D) use would have been associated with cost savings. This study was underpowered to detect a significant difference in rate reduction of anti-Rh(D) use over time. Future studies should evaluate the use of this combination in a larger population. Disclosures: No relevant conflicts of interest to declare.