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A multicenter mixed-methods study on the effects of intermittent fasting in patients with immune thrombocytopenia receiving thrombopoietin receptor agonists

Yassin MA 1 , AlRasheed M 2 , Al-Eisa T 3 , Alhashim N 4 , Alsayegh F 5 , Abouzeid TE 6 Show all authors , Abd El Fattah M 7 , Alfili M 8 , Shalaby N 9 , Alotaibi A 10 , Aljuwaisri N 11 , Almasbahi A 12 , Saleeb R 13 , Abdelaziz H 14 , Alshurafa A 1 , Ismail O 1 , Ghasoub R 15

Affiliations 

  • 1 Department of Hematology and Bone Marrow Transplant, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
  • 2 Department of Hematology, Adan Hospital, Ministry of Health, Kuwait, Kuwait
  • 3 Al-Jahra Hospital, Ministry of Health, Kuwait, Kuwait
  • 4 Department of Hematology, Mubarak Alkabeer Hospital, Ministry of Health, Kuwait, Kuwait
  • 5 College of Medicine, Kuwait University, Kuwait, Kuwait
  • 6 Internal Medicine Department, Almouwasat Hospital, Dammam, Saudi Arabia
  • 7 Accsight, Jeddah, Saudi Arabia
  • 8 Kuwait Oil Company, Ahmadi Hospital, Kuwait, Kuwait
  • 9 Department of Internal Medicine, Hematology Unit, Adan Hospital, Kuwait, Kuwait
  • 10 Department of Hematology, Sabah Hospital, Kuwait, Kuwait
  • 11 Department of Hematology Unit, Al Amiri Hospital, Kuwait, Kuwait
  • 12 Department of Hematology Unit, Jaber AlAhmad Hospital, Kuwait, Kuwait
  • 13 Department of Hematology, Amiri Hospital, Kuwait, Kuwait
  • 14 Clinical Hematology Department, Al Jahra Hospital, Ministry of Health, Kuwait, Kuwait
  • 15 Department of Pharmacy, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
Front Nutr, 2025;12:1434484.
PMID: 40098741 DOI: 10.3389/fnut.2025.1434484

Abstract

INTRODUCTION: In recent years, significant advances have been made in the treatment of immune thrombocytopenia (ITP) with the development of thrombopoietin receptor agonists (TPO-RAs). TPO-RAs are often used following the failure of prior therapies or when bleeding episodes persist despite glucocorticoid use. In Muslim countries, where religious observance includes 16/8 intermittent fasting, the timing of medication administration may be affected. This study is the first to evaluate the impact of Ramadan fasting on patients receiving different TPO-RAs.

METHODS: A multicenter mixed-design study was performed in which Muslim patients who fasted during Ramadan while receiving TPO-RAs were interviewed between 2015 and 2023. Patient responses before, during, and after Ramadan were evaluated retrospectively. The bleeding tendency was assessed as (1) no bleeding, (2) minor cutaneous/mucosal bleeding, or (3) severe bleeding that involves major organs.

RESULTS: The present study included 100 patients from three Muslim countries, including Qatar, Kuwait, and Saudi Arabia, across four tertiary centers. A complete response was observed in 63% of patients on ROM, 46% on ELT and 37% on AVA. For AVA, the mean platelet (PLT) count before Ramadan was estimated at [146.11 ± 111.76], while during Ramadan, it dropped to [131.7 ± 107.6]. For patients on ELT, the mean PLT count before Ramadan was estimated at [120.02 ± 59.7], while during Ramadan, it dropped to [100.8 ± 68.16] (p = 0.016). For patients on ROM, the mean platelet count before Ramadan was estimated at [122.68 ± 80.57], while during Ramadan, it was [130.94 ± 84.96]. Only 3% (3 patients on ELT) experienced bleeding episodes.

CONCLUSION: This study supports the feasibility of Ramadan fasting for ITP patients receiving TPO-RAs. Further studies with a larger sample size are recommended to investigate the impact of other types of fasting on the efficacy and safety of TPO-RAs.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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