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Resume Propos Le purpura thrombopenique immunologique (PTI) de l’adulte est une maladie auto-immune evoluant le plus souvent sur un mode chronique dont le traitement, une fois passee la phase initiale, n’est pas parfaitement codifie. L’objectif de cette etude etait de decrire les modalites de traitement du PTI de l’adulte en France avant la mise a disposition des agonistes du recepteur a la thrombopoietine. Methodes Etude observationnelle retrospective conduite dans huit centres hospitaliers. Les patients inclus, âges d’au moins 18 ans et atteints d’un PTI chronique, ont ete vus sur une periode allant de janvier 2004 a mars 2006. La trajectoire therapeutique des patients a ete analysee en fonction de l’anciennete du diagnostic. Resultats Les donnees de 122 patients (73 % de femmes) d’âge moyen 52,6 ans ont ete colligees. Les patients dont le PTI avait ete diagnostique depuis moins de quatre ans (n = 71) avaient recu en moyenne 2,9 lignes therapeutiques. Le traitement de premiere ligne reposait essentiellement sur la corticotherapie plus ou moins associee aux immunoglobulines intraveineuses. Des la deuxieme ligne, 12 schemas therapeutiques differents ont ete identifies. Le rituximab et la splenectomie etaient les principales modalites therapeutiques en troisieme ligne, avec une tendance a un recours moins frequent et plus tardif de la splenectomie au fil du temps. Conclusion Cette etude revele la grande heterogeneite des pratiques dans la prise en charge du PTI chronique de l’adulte en France. L’impact des recommandations nationales emises apres cette analyse tout comme la place des agonistes du recepteur a la thrombopoietine devront etre precises.

Adult immune thrombocytopenia (ITP) is an auto-immune disease with most often a chronic course for which a consensual therapeutic strategy is missing. The objective of this study was to describe treatment practices in adult ITP in France before the era of thrombopoietin receptor (TpoR) agonists.A retrospective observational study was conducted in eight hospitals in France. All eligible patients were at least 18 years of age and were seen for a chronic ITP between January 2004 and March 2006 in one of the participating centers. Data were collected retrospectively from clinical charts. ITP treatment from disease onset was analyzed for every patient according to the time of diagnosis.The study included 122 patients (73% of women) with a mean age of 52.6 years. Patients in whom ITP had been diagnosed less than 4 years earlier (n=71) received on average 2.9 treatment lines. Corticosteroids possibly combined with intravenous immunoglobulins were most often used as a first-line. From the second line, up to 12 different regimens were identified. As a third line, rituximab and splenectomy were the most common therapeutic procedures. The number of splenectomy tended to decrease over time.This analysis reflects the great heterogeneity into the management of chronic ITP. Whether such heterogeneity has declined after national guidelines have been produced remains to be assessed as well as the place of the newly develop TpoR agonists.