ISTH Guidelines recommend CABLIVI (caplacizumab-yhdp)*

SEE aTTP/iTTP

Diagnosis through clinical assessment

START CABLIVI*

Consider early administration of CABLIVI in combination with PEX and immunosuppressive therapy

SUPPORT WITH ADAMTS13

ADAMTS13 test results inform treatment decisions

*A conditional recommendation defined as desirable effects of the recommendation probably outweighing the undesirable effects. Assumes timely access to ADAMTS13 testing and clinical diagnosis based on high likelihood of aTTP/iTTP. In de novo patients where no reasonable access to ADAMTS13 activity testing is available, the Guidelines do not recommend CABLIVI; however, treatment of a patient previously diagnosed with aTTP/iTTP could be safely undertaken on clinical grounds without the need for a confirmatory ADAMTS13 test.2

ISTH TTP Guidelines are the first evidence-based, international guidelines on the diagnosis, treatment, and management of acquired/immune-mediated thrombotic thrombocytopenic purpura (aTTP/iTTP)1,2

Day 1 icon

Treatment recommendations have evolved to include PEX, immunosuppressive therapy, and CABLIVI

CABLIVI (caplacizumab-yhdp) dots

Starting CABLIVI early is believed to have the greatest benefit in the early phase of acute aTTP/iTTP events (initial or relapsing)

Identifying aTTP/iTTP is crucial for initiation of an appropriate therapeutic strategy2

    Clinical assessment

    Thrombocytopenic symbol

    Thrombocytopenia
    (<100 × 109/L)

    Platelets with schistocytes

    Evidence of MAHA§

    Platelets with schistocytes

    Relatively preserved renal function

    OR

    Risk assessment toolsǁ

    Available risk assessment tools include:

    • PLASMIC score
    • French score

    The higher the risk assessment score, the more likely patients have severe ADAMTS13 deficiency and aTTP/iTTP

    List includes laboratory tests and results only; exclusive of physical symptoms, such as petechiae.
    §Hb and hematocrit below reference range, low haptoglobin, elevated LDH, presence of schistocytes in peripheral blood smear.
    ǁISTH did not appraise the evidence for these 2 tools.

    Recommended diagnostic and management strategy for initial, acute events with access to ADAMTS13 results within 7 days

    Diagnostic and treatment algorithm adapted from ISTH Guidelines for TTP

    Who should not start CABLIVI?

    • CABLIVI is contraindicated in patients with a previous severe hypersensitivity reaction to caplacizumab-yhdp or to any of its excipients
    • Withhold CABLIVI treatment 7 days prior to elective surgery, dental procedures, or other invasive interventions

    *A conditional recommendation defined as desirable effects of the recommendation probably outweighing the undesirable effects. Assumes timely access to ADAMTS13 testing and clinical diagnosis based on high likelihood of aTTP/iTTP. In de novo patients where no reasonable access to ADAMTS13 activity testing is available, the Guidelines do not recommend CABLIVI; however, treatment of a patient previously diagnosed with aTTP/iTTP could be safely undertaken on clinical grounds without the need for a confirmatory ADAMTS13 test.2
    List includes laboratory tests and results only; exclusive of physical symptoms, such as petechiae.
    §Hb and hematocrit below reference range, low haptoglobin, elevated LDH, presence of schistocytes in peripheral blood smear.

    Adapted from ISTH Guidelines for Diagnosis of TTP.

    <10%

    Continue CABLIVI or consider STARTING CABLIVI*

    10%–20%

    Use clinical judgment to guide treatment and consider other diagnoses

    >20%

    Stop CABLIVI and consider other
    diagnoses

According to the ISTH TTP Guidelines, treatment of relapses for a patient previously diagnosed with aTTP/iTTP could be started safely based on clinical grounds without the need for a confirmatory ADAMTS13 test2

Timely access to ADAMTS13 results is key to providing optimal care for patients with aTTP/iTTP

Select US labs testing ADAMTS13 activity, inhibitors, and antibodies:

ARUP Labs

800-522-2787

LabCorp

800-334-5161

Machaon Diagnostics

800-566-3462

Mayo Clinical Laboratories

800-533-1710

Quest Diagnostics

866-697-8378

Versiti

800-245-3117 x6250

These listings do not constitute an endorsement by Sanofi and are not included in the ISTH Guidelines. The above is a selection of national laboratories offering ADAMTS13 tests for activity, inhibitor, and antibody testing. This is not an exhaustive list of labs that offer one or more of these tests or an endorsement of any lab. Other testing options may be available, including at local or regional laboratories. Content is current as of July 2020, and tests may not be available in all states. Please call laboratory to confirm test availability, sample shipping information, and all other logistics.

Day 1 icon

Choose CABLIVI on day 1 in combination with PEX and immunosuppressive therapy

Hospital and home icons

The CABLIVI dosing regimen starts in the hospital and continues at home

Who should not start CABLIVI?

  • CABLIVI is contraindicated in patients with a previous severe hypersensitivity reaction to caplacizumab-yhdp or to any of its excipients
  • Withhold CABLIVI treatment 7 days prior to elective surgery, dental procedures, or other invasive interventions


The ISTH TTP Guidelines refer to aTTP as iTTP.

ADAMTS13=a disintegrin and metalloproteinase with a thrombospondin type 1 motif, 13; Hb=hemoglobin; ISTH=International Society on Thrombosis and Haemostasis; LDH=lactate dehydrogenase; MAHA=microangiopathic hemolytic anemia; PEX=plasma exchange; TTP=thrombotic thrombocytopenic purpura.

IMPORTANT SAFETY INFORMATION AND INDICATIONS