FLIGHT
Watch Dr Charlotte Bradbury Presents FLIGHT Results
First Line treatment pathways for newly diagnosed Immune Thrombocytopenia (FLIGHT):
A Multicentre, Randomised Trial
This study examined the use of standard steroid treatment versus a combination of steroids and mycophenolate. It was led by Dr Charlotte Bradbury of University Hospitals Bristol NHS Foundation Trust.
It was the first randomised, controlled trial to compare the established initial treatment of immune thrombocytopenic purpura (ITP) with a novel approach for more than twenty years.
The target population were adults ≥ 16 years old with a diagnosis of ITP and a platelet count of <30 x 109/l who had a clinical need to start treatment. Those who had received < 1 week of steroid treatment prior to enrolling on the study were still eligible.
FLIGHT opened in May 2018 and closed in February 2019.
Findings
120 patients were recruited across 42 sites, with 105 patient samples also sent for translational studies into biomarkers for ITP. The study demonstrated the success of a multicentre trial for a relatively rare condition. Preliminary results show a greater number of treatment failures in the steroid-only arm, with no excess mycophenolate-related toxicity.
The FLIGHT paper was published in the NEJM, September 2021.
HaemSTAR Contribution
HaemSTAR supported 13 of 42 sites (32%) and recruited 43 of the 120 patients (36%). Through per patient recruitment payments, HaemSTAR brought in £8964 for the NHS.
Lay Summary
Immune thrombocytopenia (ITP) is a rare autoimmune disorder that causes low platelets, leading to bleeding and fatigue. This UK study tested whether adding the drug mycophenolate mofetil to standard steroid treatment could improve outcomes. Among 120 patients, the combination treatment led to higher platelet responses and fewer relapses than steroids alone. However, patients on the combination reported slightly worse quality of life, especially in physical function and fatigue. These findings help doctors weigh the benefits and drawbacks of adding mycophenolate for first-line ITP treatment. The study ran in 42 UK hospitals and its results were published in the New England Journal of Medicine in 2021.