Materiały źródłowe

• #1 Immune thrombocytopenia (ITP) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/idiopathic-thrombocytopenic-purpura/diagnosis-treatment/drc-20352330

  People with mild immune thrombocytopenia might need only regular platelet checks. […] Most adults with ITP will need treatment at some point. The condition often gets worse or lasts long, also known as chronic. […] Treatment might include medicines to increase platelet count or surgery to remove the spleen, known as a splenectomy. […] Some people find the side effects of treatment are worse than the disease. […] Medicines to treat ITP may include: […] Health care providers often use an oral corticosteroid, such as prednisone. […] If corticosteroids don’t work, a shot of immune globulin might help. […] Medicines such as romiplostim (Nplate), eltrombopag (Promacta) and avatrombopag (Doptelet) help bone marrow make more platelets. […] Rituximab (Rituxan, Ruxience, Truxima) helps increase the platelet count by reducing the immune system response damaging them.

• #2 Recent advances in treatments of adult immune thrombocytopenia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9057657/

  Immune thrombocytopenia (ITP) is isolated thrombocytopenia characterized by autoimmune-mediated disruption of platelet without other etiologies. Treatments for chronic ITP consist of corticosteroids, intravenous immunoglobulins, anti-D immunoglobulin, rituximab, thrombopoietin receptor agonists, immunosuppressants and splenectomy. Although current therapies are effective in over two-thirds of patients, some patients are refractory to therapies or fail to achieve long-term responses. Recently, great advance has been made in identifying various mechanisms involved in ITP pathogenesis, and new treatments targeting these pathways are being developed. Novel agents such as splenic tyrosine kinase inhibitor, Bruton kinase inhibitor, plasma cell targeting therapies, neonatal Fc receptor inhibitor, platelet desialylation inhibitor, and inhibition of the classical complement pathway are expected to be effective for ITP treatment. This review summarizes current strategies and emerging therapies of ITP.

• #3 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  Primary immune thrombocytopenia (ITP) is an immune-mediated bleeding disorder characterized by decreased platelet counts and an increased risk of bleeding. […] Treatment is not required except for patients with active bleeding, severe thrombocytopenia, or cases in need of invasive procedures. Corticosteroids, intravenous immunoglobulin, and anti-RhD immunoglobulin are the classical initial treatments for newly diagnosed ITP in adults, but these agents generally cannot induce a long-term response in most patients. […] Subsequent treatments for patients who fail the initial therapy include thrombopoietic agents, rituximab, fostamatinib, splenectomy, and several older immunosuppressive agents. […] An optimized treatment strategy should aim at elevating the platelet counts to a safety level with minimal toxicity and improving patient health-related quality of life, and always needs to be tailored to the patients and disease phases.

• #4 Second-line therapies in immune thrombocytopenia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6142486/

  Immune thrombocytopenia (ITP) is a rare, acquired autoimmune condition characterized by a low platelet count and an increased risk of bleeding. […] Selecting a second-line therapy depends on the reason for treatment, which can vary from bleeding to implications for health-related quality of life (HRQoL) to likelihood of remission and patient preference with regard to adverse effects, route of administration, and cost. […] Second-line treatments, which, for this manuscript, include therapies beyond observation, steroids, IVIG, and anti-D globulin, can induce a sustained increase in the platelet count with ongoing treatment and/or may alter the disease. […] Shared decision-making is also critical, given that these agents vary considerably with regard to cost, ease of administration, potential adverse effects, and likelihood of remission, all of which may influence patient preference.

• #5 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  The main goals of ITP treatment are to prevent bleeding and maintain the platelet count above a safe level to minimize the bleeding tendency. […] The updated ASH guidelines recommend the initiation of disease-specific treatments if the platelet counts are <30 × 10^9/L, while it is a recommendation based on very low certainty in the evidence of effects. [...] Corticosteroids remain the initial cornerstone therapy for ITP patients without relative contraindications. [...] IVIg is another commonly used initial therapy that can raise the platelet counts rapidly in more than 80% of newly diagnosed ITP patients; however, it is relatively expensive and the response is usually transient. [...] Anti-RhD Ig has been proposed as an alternative to IVIg in Rh-positive patients with intact spleens. [...] Neither corticosteroids, IVIg, nor anti-RhD Ig is able to modify the natural course of ITP by preventing its chronic evolution.

• #6 Immune Thrombocytopenia (ITP) Treatment & Management: Approach Considerations, Thrombopoietin Receptor Agonists, Treatment in Children

  https://emedicine.medscape.com/article/202158-treatment

  In the past decade, thrombopoietin receptor agonists (TPO-RAs) have entered clinical practice as second-line agents, with robust evidence supporting their efficacy. […] Three TPO-RAs are currently available: romiplostin (Nplate), eltrombopag (Promacta), and avatrombopag (Doptelet). […] Romiplostin became available for patients with chronic ITP in 2008. […] Eltrombopag also became available in 2008. […] Avatrombopag, an oral TPO receptor agonist, was approved by the FDA in 2019 for adults with chronic ITP who have had an insufficient response to a previous treatment. […] For pediatric patients requiring treatment, ASH suggests a short course of corticosteroids for first-line treatment rather than IVIG or anti-D immunoglobulin. […] In adults, treatment is recommended for a platelet count 30 109/L.

• #7 Immune thrombocytopenia (ITP) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/idiopathic-thrombocytopenic-purpura/diagnosis-treatment/drc-20352330

  People with mild immune thrombocytopenia might need only regular platelet checks. […] Most adults with ITP will need treatment at some point. The condition often gets worse or lasts long, also known as chronic. […] Treatment might include medicines to increase platelet count or surgery to remove the spleen, known as a splenectomy. […] Some people find the side effects of treatment are worse than the disease. […] Medicines to treat ITP may include: […] Health care providers often use an oral corticosteroid, such as prednisone. […] If corticosteroids don’t work, a shot of immune globulin might help. […] Medicines such as romiplostim (Nplate), eltrombopag (Promacta) and avatrombopag (Doptelet) help bone marrow make more platelets. […] Rituximab (Rituxan, Ruxience, Truxima) helps increase the platelet count by reducing the immune system response damaging them.

• #8 Immune Thrombocytopenia (ITP): Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/5726-immune-thrombocytopenia

  Whats the treatment for immune thrombocytopenia? Often, children with immune thrombocytopenia have mild symptoms and dont need treatment, but most adults will. If you do need treatment, your healthcare provider may prescribe medications to boost your platelet count or keep your immune system from attacking your platelets. Medications may include: […] Your provider may recommend other steps like: […] Medications, transfusions and surgery may cause several different side effects. Your healthcare provider will discuss treatment side effects, so you know what to expect. […] The outlook varies depending on your or your childs unique situation. If your child has ITP, theyll probably get better within a few weeks or months without needing treatment. If you have persistent or chronic ITP, you may need medications and other treatments to manage your symptoms depending on how low your platelet count is, but youll always have the condition. Healthcare providers cant cure immune thrombocytopenia, but many people with chronic ITP live for decades with the condition.

• #9 Immune Thrombocytopenia (ITP) Treatment & Management: Approach Considerations, Thrombopoietin Receptor Agonists, Treatment in Children

  https://emedicine.medscape.com/article/202158-treatment

  The goal of medical care for immune thrombocytopenia (ITP) is to increase the platelet count to a safe level, permitting patients to live normal lives while awaiting spontaneous or treatment-induced remission. ITP has no cure, and relapses may occur years after seemingly successful medical or surgical management. […] The treatment paradigm is shifting, with expanding experience with earlier use of thrombopoietin receptor analogs (TPO-RA; TPO-mimetics) in chronic ITP. However, this is not yet the standard of care. […] Corticosteroids (ie, oral prednisone or high-dose dexamethasone) remain the drugs of choice for the initial management of acute ITP, especially in the setting of life-threatening thrombocytopenia or when response in the platelet count is needed in an urgent or emergent setting.

• #10 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  The main goals of ITP treatment are to prevent bleeding and maintain the platelet count above a safe level to minimize the bleeding tendency. […] The updated ASH guidelines recommend the initiation of disease-specific treatments if the platelet counts are <30 × 10^9/L, while it is a recommendation based on very low certainty in the evidence of effects. [...] Corticosteroids remain the initial cornerstone therapy for ITP patients without relative contraindications. [...] IVIg is another commonly used initial therapy that can raise the platelet counts rapidly in more than 80% of newly diagnosed ITP patients; however, it is relatively expensive and the response is usually transient. [...] Anti-RhD Ig has been proposed as an alternative to IVIg in Rh-positive patients with intact spleens. [...] Neither corticosteroids, IVIg, nor anti-RhD Ig is able to modify the natural course of ITP by preventing its chronic evolution.

• #11 Treatment of Immune Thrombocytopenic Purpura

  https://www.medscape.org/viewarticle/559937

  Immune thrombocytopenic purpura (ITP) is a disorder mediated by antiplatelet antibodies and characterized by accelerated destruction of platelets and impaired platelet production. […] Recent advances in our understanding of the specific pathways involved in immune-mediated platelet destruction and the significance of suboptimal thrombopoiesis have led to the development and investigation of new therapeutic agents. […] The mainstay therapies for ITP have included corticosteroids, the immune globulins intravenous immunoglobulin (IVIG) and IV anti-D, danazol, azathioprine, cyclophosphamide, and splenectomy. […] Immunosuppressive therapy with corticosteroids has long been a first-line therapy for ITP. […] Prednisone at a starting dose of 1.0-2.0 mg/kg for 2-4 weeks, with tapering if a platelet response occurs, leads to a response rate of 60% to 70% in adults, with long-term remission occurring in 10% to 20% of those who respond.

• #12 Treatment of Immune Thrombocytopenic Purpura

  https://www.medscape.org/viewarticle/559937

  Recently, the efficacy of pulsed, high-dose dexamethasone not only in acutely increasing the platelet count, but also in effecting a long-term „cure,” has been examined. […] IVIG and anti-D acutely increase the platelet count by inhibition of FcR-mediated destruction of antibody-coated platelets. […] A meta-analysis of randomized controlled trials reported that treatment with IVIG results in a more rapid rise in platelet count compared with corticosteroids. […] Rituximab, a monoclonal anti-CD20 antibody that transiently depletes CD20+ B cells, is approved for treatment of non-Hodgkin’s lymphoma and has been studied in ITP. […] These trials in ITP have shown promising efficacy for both short-term and long-term response rates. […] Several new agents are in clinical trials for the treatment of ITP.

• #13 Immune Thrombocytopenia (ITP) – Hematology and Oncology – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hematology-and-oncology/thrombocytopenia-and-platelet-dysfunction/immune-thrombocytopenia-itp

  Splenectomy can achieve a complete remission in about two thirds of patients who relapse after initial corticosteroid therapy. […] If thrombocytopenia can be controlled with second-line medical therapies, splenectomy is often not necessary. […] Second-line medical therapies include thrombopoietin receptor agonists (TPO-RAs), rituximab, fostamatinib, or other immunosuppressive drugs. […] In children or adults with immune thrombocytopenia and life-threatening bleeding, rapid phagocytic blockade is attempted by giving IVIG 1 g/kg once a day for 1 to 2 days or, in Rh-positive patients, a single dose of IV anti-D immune globulin 75 mcg/kg. […] High-dose methylprednisolone (1 g IV once a day for 3 days) is easier to administer than IVIG or IV anti-D immune globulin but may not be as effective.

• #14 Treatment of Immune Thrombocytopenic Purpura

  https://www.medscape.org/viewarticle/559937

  Immune thrombocytopenic purpura (ITP) is a disorder mediated by antiplatelet antibodies and characterized by accelerated destruction of platelets and impaired platelet production. […] Recent advances in our understanding of the specific pathways involved in immune-mediated platelet destruction and the significance of suboptimal thrombopoiesis have led to the development and investigation of new therapeutic agents. […] The mainstay therapies for ITP have included corticosteroids, the immune globulins intravenous immunoglobulin (IVIG) and IV anti-D, danazol, azathioprine, cyclophosphamide, and splenectomy. […] Immunosuppressive therapy with corticosteroids has long been a first-line therapy for ITP. […] Prednisone at a starting dose of 1.0-2.0 mg/kg for 2-4 weeks, with tapering if a platelet response occurs, leads to a response rate of 60% to 70% in adults, with long-term remission occurring in 10% to 20% of those who respond.

• #15 Updated Recommendations for the Treatment of Immune Thrombocytopenia – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/august-2020/updated-recommendations-for-the-treatment-of-immune-thrombocytopenia/

  JCThe decision to start treatment in adults with ITP is guided by the platelet count and symptoms of bleeding. […] The current 2019 guidelines from the American Society of Hematology (ASH) recommend treatment in adults with newly diagnosed disease who are having clinically important bleeding. […] IT is a treatable chronic disease. Because treatment is generally not curative and relapses can occur years later, the goal of therapy is to stabilize the platelet count in a safe range, not necessarily to normalize the count. […] Corticosteroids remain the frontline therapy of choice in adults with newly diagnosed ITP, but now a shorter duration of therapy—6 weeks or fewer—is recommended in place of the previously recommended longer courses plus taper. […] Intravenous immunoglobulin (IVIG) and anti-D therapy are still frontline options for patients in whom corticosteroids are contraindicated.

• #16 Immune Thrombocytopenia (ITP) Treatment & Management: Approach Considerations, Thrombopoietin Receptor Agonists, Treatment in Children

  https://emedicine.medscape.com/article/202158-treatment

  The ASH recommends that if treatment is needed, shorter courses of corticosteroids (6 weeks) are preferred over prolonged courses as first-line treatment. […] In adults with ITP lasting 3 months who are corticosteroid-dependent or have no response to corticosteroids, the ASH guidelines suggest either splenectomy or a TPO-RA. […] Fostamatinib (Tavalisse) was approved by the US Food and Drug Administration (FDA) in 2018 for thrombocytopenia in adults with chronic ITP who have had an insufficient response to a previous treatment. […] Pregnant women with no bleeding manifestations whose platelet counts are 30 109/L or higher do not require any treatment until 36 weeks’ gestation, unless delivery is imminent. […] Refractory ITP in pregnancy can be treated with corticosteroids and IVIG in combination, or splenectomy (in the second trimester). […] In persons with acute immune thrombocytopenia (ITP), splenectomy usually results in rapid, complete, and life-long clinical remission. […] If 6 months of medical management fails to increase the platelet count to a safe range (about 30,000/L), splenectomy becomes an option.

• #17 Idiopathic Thrombocytopenic Purpura (ITP) | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/idiopathic-thrombocytopenic-purpura-itp

  Specific treatment for ITP will be determined by your child’s physician based on: […] Not all children with ITP require treatment. Close monitoring of your child’s platelets and prevention of serious bleeding complications may be the course of action chosen until the body is able to correct the disorder on its own. Many children with ITP are able to spontaneously recover in about 2 to 4 days. […] When treatment is necessary, the two most common forms of treatment are: […] Steroids, which help prevent bleeding by decreasing the rate of platelet destruction. Steroids, if effective, will result in an increase in platelet counts seen within two to three weeks. Side effects may include irritability, stomach irritation, weight gain, hypertension and acne. […] Intravenous gamma globulin (IVGG), a protein that contains many antibodies and also slows the destruction of platelets. IVGG works more quickly than steroids (within 24 to 48 hours).

• #18 Recent advances in treatments of adult immune thrombocytopenia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9057657/

  Current therapies for chronic ITP [e.g., corticosteroid, thrombopoietin receptor agonists (TPO-RA), rituximab and splenectomy] are successful in improving platelet count to a stable level in over two-thirds of adult patients. However, some patients still have an inadequate response with current treatments, so there is a great need for other therapies. […] The preferred first-line therapy for patients with chronic ITP is oral corticosteroids, unless there is a contraindication to corticosteroids or need for more rapid platelet increase due to acute bleeding. […] Intravenous immunoglobulin (IVIG) has been widely used as first-line anti-ITP therapy with or without corticosteroids since its effectiveness in treating ITP was first demonstrated in 1981. […] Anti-D immunoglobulin is an immune globulin directed against the D antigen of the Rh blood group system.

• #19 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  The main goals of ITP treatment are to prevent bleeding and maintain the platelet count above a safe level to minimize the bleeding tendency. […] The updated ASH guidelines recommend the initiation of disease-specific treatments if the platelet counts are <30 × 10^9/L, while it is a recommendation based on very low certainty in the evidence of effects. [...] Corticosteroids remain the initial cornerstone therapy for ITP patients without relative contraindications. [...] IVIg is another commonly used initial therapy that can raise the platelet counts rapidly in more than 80% of newly diagnosed ITP patients; however, it is relatively expensive and the response is usually transient. [...] Anti-RhD Ig has been proposed as an alternative to IVIg in Rh-positive patients with intact spleens. [...] Neither corticosteroids, IVIg, nor anti-RhD Ig is able to modify the natural course of ITP by preventing its chronic evolution.

• #20 Immune Thrombocytopenia (ITP) – Hematology and Oncology – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hematology-and-oncology/thrombocytopenia-and-platelet-dysfunction/immune-thrombocytopenia-itp

  Splenectomy can achieve a complete remission in about two thirds of patients who relapse after initial corticosteroid therapy. […] If thrombocytopenia can be controlled with second-line medical therapies, splenectomy is often not necessary. […] Second-line medical therapies include thrombopoietin receptor agonists (TPO-RAs), rituximab, fostamatinib, or other immunosuppressive drugs. […] In children or adults with immune thrombocytopenia and life-threatening bleeding, rapid phagocytic blockade is attempted by giving IVIG 1 g/kg once a day for 1 to 2 days or, in Rh-positive patients, a single dose of IV anti-D immune globulin 75 mcg/kg. […] High-dose methylprednisolone (1 g IV once a day for 3 days) is easier to administer than IVIG or IV anti-D immune globulin but may not be as effective.

• #21 Treatment of Immune Thrombocytopenia: Contextualization from a Historical Perspective

  https://www.mdpi.com/2038-8330/16/3/39

  The treatment of ITP has the following two main objectives: on the one hand, to maintain a platelet count that prevents severe bleeding, which is usually achieved with platelet counts greater than 30–50 × 10^9/L, and, on the other hand, to avoid unnecessary treatments in asymptomatic patients, since the side effects may be more important than the complications derived from the disease itself. Therefore, treatment should be individualized, and the goal should not be to normalize the platelet count. […] The increase in platelet counts with glucocorticoids, adrenocorticotropic hormone (ACTH), or other immunosuppressive agents has been described since 1951. […] The introduction of IVIGs by Imbach et al. in 1981 was a milestone in the treatment of symptomatic ITP in children. […] IVIGs are purified from the plasma of healthy donors and mainly contain polyclonal IgG.

• #22 LCD – Immune Thrombocytopenia (ITP) Therapy (L38268)

  https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdId=38268&ver=9

  Thrombopoietin receptor agonist (TPO-RA) will be covered when all of the following criteria are met: […] Rituximab will be covered when all of the following criteria are met: […] The goal of treatment is to prevent severe bleeding, but the risk of bleeding can be difficult to estimate. […] Corticosteroids are the standard first-line treatment when treatment is required and consistent with society guidelines. […] Intravenous immune globulin (IVIg) has been demonstrated to be effective in controlled trails with an initial response in 24-48 hours and duration of 2-6 weeks. […] Second line therapies are indicated in chronic and severe ITP when a patient fails to respond to first-line therapy. […] The American Society of Hematology (ASH) 2019 Guidelines for ITP recommends In adults with ITP lasting 3 months who are corticosteroid-dependent or have no response to corticosteroids, the ASH guideline panel suggests either splenectomy or a TPO-RA.

• #23 Immune thrombocytopenic purpura (ITP) | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/idiopathic-thrombocytopenic-purpura-itp

  intravenous immunoglobulin (IVIG) this is a blood product that consists of concentrated antibodies. It is thought that the autoantibodies might be swamped by IVIG, reducing their ability to target platelets. IVIG has to be given by an intravenous infusion and may take a couple of hours. […] Second-line treatments (those used if the first-line treatments do not work) include: splenectomy surgical removal of the spleen. This operation cures ITP in about 70 per cent of chronic cases […] thrombopoietin analogues treatment to increase production of new platelets in the bone marrow […] monoclonal antibodies to CD20 an injection treatment targeting antibody-producing cells. […] Occasionally, a person who appears to have been cured of ITP will experience a relapse, perhaps months or even years after the initial episode. If this happens the person will need repeat treatment. The relapse may be triggered by a viral infection.

• #24 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  The main goals of ITP treatment are to prevent bleeding and maintain the platelet count above a safe level to minimize the bleeding tendency. […] The updated ASH guidelines recommend the initiation of disease-specific treatments if the platelet counts are <30 × 10^9/L, while it is a recommendation based on very low certainty in the evidence of effects. [...] Corticosteroids remain the initial cornerstone therapy for ITP patients without relative contraindications. [...] IVIg is another commonly used initial therapy that can raise the platelet counts rapidly in more than 80% of newly diagnosed ITP patients; however, it is relatively expensive and the response is usually transient. [...] Anti-RhD Ig has been proposed as an alternative to IVIg in Rh-positive patients with intact spleens. [...] Neither corticosteroids, IVIg, nor anti-RhD Ig is able to modify the natural course of ITP by preventing its chronic evolution.

• #25 Recent advances in treatments of adult immune thrombocytopenia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9057657/

  Current therapies for chronic ITP [e.g., corticosteroid, thrombopoietin receptor agonists (TPO-RA), rituximab and splenectomy] are successful in improving platelet count to a stable level in over two-thirds of adult patients. However, some patients still have an inadequate response with current treatments, so there is a great need for other therapies. […] The preferred first-line therapy for patients with chronic ITP is oral corticosteroids, unless there is a contraindication to corticosteroids or need for more rapid platelet increase due to acute bleeding. […] Intravenous immunoglobulin (IVIG) has been widely used as first-line anti-ITP therapy with or without corticosteroids since its effectiveness in treating ITP was first demonstrated in 1981. […] Anti-D immunoglobulin is an immune globulin directed against the D antigen of the Rh blood group system.

• #26 Immune Thrombocytopenia (ITP): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/202158-overview

  Corticosteroids remain the drugs of choice for the initial management of acute ITP. […] Oral prednisone, IV methylprednisolone, or high-dose dexamethasone may be used. […] IV immunoglobulin (IVIG) has been the drug of second choice for many years. […] For Rh(D)-positive patients with intact spleens, IV Rho immunoglobulin (RhIG) offers comparable efficacy, less toxicity, greater ease of administration, and a lower cost than IVIG. […] Options in patients with corticosteroid dependence or unresponsiveness include thrombopoietin receptor agonists (TPO-RAs; ie, romiplostim, eltrombopag, avatrombopag), rituximab, or splenectomy. […] TPO-RAs may maintain platelet counts at safe levels in patients with chronic ITP refractory to splenectomy. […] If the platelet count is less than 50 109/L (50 103/L) before delivery, treatment with oral prednisone and IVIG is recommended. […] Rarely, splenectomy may be required to manage acute hemorrhage.

• #27 Immune thrombocytopenic purpura – Wikipedia

  https://en.wikipedia.org/wiki/Immune_thrombocytopenic_purpura

  Immune thrombocytopenic purpura (ITP), also known as idiopathic thrombocytopenic purpura or immune thrombocytopenia, is an autoimmune primary disorder of hemostasis characterized by a low platelet count in the absence of other causes. […] For mild cases, careful observation may be sufficient. However, in instances of very low platelet counts or significant bleeding, treatment options may include corticosteroids, intravenous immunoglobulin, anti-D immunoglobulin, or immunosuppressive medications. […] Initial treatment usually consists of the administration of corticosteroids, a group of medications that suppress the immune system. […] Another option, suitable for Rh-positive patients with functional spleens is intravenous administration of Rho(D) immune globulin. […] There is increasing use of immunosuppressants such as mycophenolate mofetil and azathioprine because of their effectiveness.

• #28 Immune Thrombocytopenia (ITP) – Hematology and Oncology – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hematology-and-oncology/thrombocytopenia-and-platelet-dysfunction/immune-thrombocytopenia-itp

  Splenectomy can achieve a complete remission in about two thirds of patients who relapse after initial corticosteroid therapy. […] If thrombocytopenia can be controlled with second-line medical therapies, splenectomy is often not necessary. […] Second-line medical therapies include thrombopoietin receptor agonists (TPO-RAs), rituximab, fostamatinib, or other immunosuppressive drugs. […] In children or adults with immune thrombocytopenia and life-threatening bleeding, rapid phagocytic blockade is attempted by giving IVIG 1 g/kg once a day for 1 to 2 days or, in Rh-positive patients, a single dose of IV anti-D immune globulin 75 mcg/kg. […] High-dose methylprednisolone (1 g IV once a day for 3 days) is easier to administer than IVIG or IV anti-D immune globulin but may not be as effective.

• #29 Pediatric immune thrombocytopenia (ITP) treatment – Kim – Annals of Blood

  https://aob.amegroups.org/article/view/6316/html

  If a more rapid rise in platelets is desired, IV methylprednisolone may be used. […] Anti-D is another frontline option in children who require treatment. […] Anti-D typically induces a rise in platelet counts within 24-48 hours for approximately 50-77% of children. […] Increasingly, thrombopoietin receptor agonists (TPO-RAs) are being used earlier in the management of pediatric ITP. […] TPO-RAs may have a role as adjunct in the setting of severe or life-threatening bleeding. […] Second line agents are indicated for children who do not respond or relapse after first line agents. […] Increasingly TPO-RAs are being utilized as the initial second line agent for pediatric ITP patients who do not respond to upfront therapies. […] Eltrombopag was approved for use in children with chronic ITP in 2015 following two multicenter, double-blind, placebo controlled trials.

• #30 Immune thrombocytopenia – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/immune-thrombocytopenia/

  First-line medical therapy consists of corticosteroids, intravenous immunoglobulin (IVIG), or anti-Rho(D) immunoglobulin. […] Anti-Rho(D) immunoglobulin can cause potentially fatal intravascular hemolysis in patients with ITP. Close monitoring is recommended. […] The following options should be considered in consultation with a specialist for patients with newly-diagnosed ITP refractory to first-line medical therapy, or persistent/chronic ITP. […] Thrombopoietin receptor agonists (TPO-RAs) should be considered for patients with newly-diagnosed ITP refractory to first-line medical therapy, or persistent/chronic ITP.

• #31 Recent advances in treatments of adult immune thrombocytopenia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9057657/

  Most of ITP patients respond to primary treatment such as glucocorticoids or IVIG, but a significant number of patients eventually require secondary treatment because the maintain of long-term responses are difficult. Such patients may consider medical therapy (TPO-RA, rituximab) or surgical option (splenectomy). […] TPO-RAs are small molecule that stimulates thrombopoietin to increase the production of platelets by megakaryocytes in bone marrow. Currently, there are three agents (eltrombopag, romiplostim and avatrombopag) that have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of chronic ITP. […] Because B-cell plays an important role in pathogenesis of ITP, rituximab, chimeric monoclonal antibody against CD20 on the surface of B-lymphocyte has been proposed for many years to treatment of ITP.

• #32 The treatment of immune thrombocytopenia (ITP)—focus on thrombopoietin receptor agonists – Kuter – Annals of Blood

  https://aob.amegroups.org/article/view/6335/html

  Immune thrombocytopenia (ITP) is an autoimmune disease characterized by increased platelet destruction along with reduced platelet production. All treatments attempt either to reduce the rate of platelet production or increase the rate of platelet production. […] New treatment guidelines have supported a shift from corticosteroids and splenectomy to newer medical treatments that mitigate the thrombocytopenia and avoid splenectomy. The thrombopoietin receptor agonists (TPO-RA), romiplostim, eltrombopag, and avatrombopag, have markedly altered the treatment of ITP. Response rates of 80-90% are routinely obtained and responses are usually maintained with continued therapy. […] Current guidelines encourage their use as early as 3 months into the disease course, sometimes even earlier. TPO-RA do not need to be continued forever; about a third of patients in the first year and about another third after two years have a remission.

• #33 Immune Thrombocytopenia (ITP) Treatment & Management: Approach Considerations, Thrombopoietin Receptor Agonists, Treatment in Children

  https://emedicine.medscape.com/article/202158-treatment

  In the past decade, thrombopoietin receptor agonists (TPO-RAs) have entered clinical practice as second-line agents, with robust evidence supporting their efficacy. […] Three TPO-RAs are currently available: romiplostin (Nplate), eltrombopag (Promacta), and avatrombopag (Doptelet). […] Romiplostin became available for patients with chronic ITP in 2008. […] Eltrombopag also became available in 2008. […] Avatrombopag, an oral TPO receptor agonist, was approved by the FDA in 2019 for adults with chronic ITP who have had an insufficient response to a previous treatment. […] For pediatric patients requiring treatment, ASH suggests a short course of corticosteroids for first-line treatment rather than IVIG or anti-D immunoglobulin. […] In adults, treatment is recommended for a platelet count 30 109/L.

• #34 The treatment of immune thrombocytopenia (ITP)—focus on thrombopoietin receptor agonists – Kuter – Annals of Blood

  https://aob.amegroups.org/article/view/6335/html

  With the introduction of TPO-RA, rituximab and fostamatinib, therapeutic options for treating ITP have evolved from our prior standard care of corticosteroids and splenectomy. […] The TPO-RA have markedly changed the approach to treating ITP. In clinical trials they have shown response rates as high as 93%, onset of action often in 7 to 14 days, minimal side effects, a sustained duration of effect and improved HRQoL. […] Our general practice is to start a TPO-RA and then gradually taper the patient off the remaining corticosteroids over the next 4 weeks. Most patients can be subsequently maintained on the TPO-RA alone. […] In some patients with other underlying autoimmune disorders, increased risk of thrombosis, or concurrent hemolytic anemia we will instead use rituximab despite its lower response rate and shorter duration of effect.

• #35 Immune Thrombocytopenia (ITP) Treatment & Management: Approach Considerations, Thrombopoietin Receptor Agonists, Treatment in Children

  https://emedicine.medscape.com/article/202158-treatment

  In the past decade, thrombopoietin receptor agonists (TPO-RAs) have entered clinical practice as second-line agents, with robust evidence supporting their efficacy. […] Three TPO-RAs are currently available: romiplostin (Nplate), eltrombopag (Promacta), and avatrombopag (Doptelet). […] Romiplostin became available for patients with chronic ITP in 2008. […] Eltrombopag also became available in 2008. […] Avatrombopag, an oral TPO receptor agonist, was approved by the FDA in 2019 for adults with chronic ITP who have had an insufficient response to a previous treatment. […] For pediatric patients requiring treatment, ASH suggests a short course of corticosteroids for first-line treatment rather than IVIG or anti-D immunoglobulin. […] In adults, treatment is recommended for a platelet count 30 109/L.

• #36 Second-line therapies in immune thrombocytopenia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6142486/

  The thrombopoietin receptor agonists (TPO-RAs) bind to and stimulate the TPO receptor and increase platelet production. […] Eltrombopag is also approved for children older than 1 year who have chronic ITP. […] Randomized trials in children and adults have demonstrated an initial platelet response with eltrombopag of 59% to 75%, and a durable response with continued treatment of 62%. […] A study of 21 refractory patients reported a response rate of 53% with a platelet count higher than 50 109/L within 12 weeks of initiation and with continued response up to a median of 24 weeks. […] A review of published case series in children and adults with ITP reports an overall platelet response to dapsone of 40% to 62%. […] Splenectomy is the most predictable method for achieving a durable remission.

• #37 Immune Thrombocytopenia (ITP) Treatment & Management: Approach Considerations, Thrombopoietin Receptor Agonists, Treatment in Children

  https://emedicine.medscape.com/article/202158-treatment

  In the past decade, thrombopoietin receptor agonists (TPO-RAs) have entered clinical practice as second-line agents, with robust evidence supporting their efficacy. […] Three TPO-RAs are currently available: romiplostin (Nplate), eltrombopag (Promacta), and avatrombopag (Doptelet). […] Romiplostin became available for patients with chronic ITP in 2008. […] Eltrombopag also became available in 2008. […] Avatrombopag, an oral TPO receptor agonist, was approved by the FDA in 2019 for adults with chronic ITP who have had an insufficient response to a previous treatment. […] For pediatric patients requiring treatment, ASH suggests a short course of corticosteroids for first-line treatment rather than IVIG or anti-D immunoglobulin. […] In adults, treatment is recommended for a platelet count 30 109/L.

• #38 Chronic Immune Thrombocytopenia (ITP) Treatment | DOPTELET® (avatrombopag)

  https://doptelet.com/home/

  Doptelet is an oral chronic ITP medication that helps increase platelet counts to 50,000 per microliter or more, in as few as 8 days, and can keep them lifted for an average of 12 total weeks. […] Doptelet is a prescription medicine used to help treat low blood platelet counts in adults with chronic immune thrombocytopenia (ITP) when other treatments have not worked well enough. It is not known if Doptelet is safe or works in children. […] For patients with chronic ITP, the most common side effects are headache, fatigue, bruising, nosebleeds, upper respiratory tract infection, joint pain, bleeding gums, purple or red spots on your skin (petechiae), and runny nose.

• #39 The treatment of immune thrombocytopenia (ITP)—focus on thrombopoietin receptor agonists – Kuter – Annals of Blood

  https://aob.amegroups.org/article/view/6335/html

  Immune thrombocytopenia (ITP) is an autoimmune disease characterized by increased platelet destruction along with reduced platelet production. All treatments attempt either to reduce the rate of platelet production or increase the rate of platelet production. […] New treatment guidelines have supported a shift from corticosteroids and splenectomy to newer medical treatments that mitigate the thrombocytopenia and avoid splenectomy. The thrombopoietin receptor agonists (TPO-RA), romiplostim, eltrombopag, and avatrombopag, have markedly altered the treatment of ITP. Response rates of 80-90% are routinely obtained and responses are usually maintained with continued therapy. […] Current guidelines encourage their use as early as 3 months into the disease course, sometimes even earlier. TPO-RA do not need to be continued forever; about a third of patients in the first year and about another third after two years have a remission.

• #40 The treatment of immune thrombocytopenia (ITP)—focus on thrombopoietin receptor agonists – Kuter – Annals of Blood

  https://aob.amegroups.org/article/view/6335/html

  With the introduction of TPO-RA, rituximab and fostamatinib, therapeutic options for treating ITP have evolved from our prior standard care of corticosteroids and splenectomy. […] The TPO-RA have markedly changed the approach to treating ITP. In clinical trials they have shown response rates as high as 93%, onset of action often in 7 to 14 days, minimal side effects, a sustained duration of effect and improved HRQoL. […] Our general practice is to start a TPO-RA and then gradually taper the patient off the remaining corticosteroids over the next 4 weeks. Most patients can be subsequently maintained on the TPO-RA alone. […] In some patients with other underlying autoimmune disorders, increased risk of thrombosis, or concurrent hemolytic anemia we will instead use rituximab despite its lower response rate and shorter duration of effect.

• #41 The treatment of immune thrombocytopenia (ITP)—focus on thrombopoietin receptor agonists – Kuter – Annals of Blood

  https://aob.amegroups.org/article/view/6335/html

  Immune thrombocytopenia (ITP) is an autoimmune disease characterized by increased platelet destruction along with reduced platelet production. All treatments attempt either to reduce the rate of platelet production or increase the rate of platelet production. […] New treatment guidelines have supported a shift from corticosteroids and splenectomy to newer medical treatments that mitigate the thrombocytopenia and avoid splenectomy. The thrombopoietin receptor agonists (TPO-RA), romiplostim, eltrombopag, and avatrombopag, have markedly altered the treatment of ITP. Response rates of 80-90% are routinely obtained and responses are usually maintained with continued therapy. […] Current guidelines encourage their use as early as 3 months into the disease course, sometimes even earlier. TPO-RA do not need to be continued forever; about a third of patients in the first year and about another third after two years have a remission.

• #42 New Strategies for the Treatment of Immune Thrombocytopenia – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/march-2022/new-strategies-for-the-treatment-of-immune-thrombocytopenia/

  Researchers are trying to reduce the duration of high-dose corticosteroid management to minimize the complications that occur with long-term use. […] Researchers are moving treatment with the medications that have been licensed by the FDA for chronic ITP into earlier phases. […] Researchers are working to identify approaches that will lead to a more rapid platelet count response in patients with ITP, hoping to reduce the use of corticosteroids and increase the durability of the response. […] In a study from France, Dr Mathieu Mahevas and colleagues identified 49 patients with persistent or chronic ITP as part of a nationwide, prospective, multicenter interventional study. […] These results are remarkable and important because they show that we may be able to limit the use of TPO receptor agonists after at least 3 months of treatment.

• #43 Immune Thrombocytopenia (ITP) Treatment & Management: Approach Considerations, Thrombopoietin Receptor Agonists, Treatment in Children

  https://emedicine.medscape.com/article/202158-treatment

  The ASH recommends that if treatment is needed, shorter courses of corticosteroids (6 weeks) are preferred over prolonged courses as first-line treatment. […] In adults with ITP lasting 3 months who are corticosteroid-dependent or have no response to corticosteroids, the ASH guidelines suggest either splenectomy or a TPO-RA. […] Fostamatinib (Tavalisse) was approved by the US Food and Drug Administration (FDA) in 2018 for thrombocytopenia in adults with chronic ITP who have had an insufficient response to a previous treatment. […] Pregnant women with no bleeding manifestations whose platelet counts are 30 109/L or higher do not require any treatment until 36 weeks’ gestation, unless delivery is imminent. […] Refractory ITP in pregnancy can be treated with corticosteroids and IVIG in combination, or splenectomy (in the second trimester). […] In persons with acute immune thrombocytopenia (ITP), splenectomy usually results in rapid, complete, and life-long clinical remission. […] If 6 months of medical management fails to increase the platelet count to a safe range (about 30,000/L), splenectomy becomes an option.

• #44 Second-Line Treatment of Persistent Immune Thrombocytopenia – Hematology Advisor

  https://www.hematologyadvisor.com/cch/second-line-treatment-persistent-immune-thrombocytopenia/

  TPO-RAs are currently the only therapy specifically developed to treat ITP. […] The TPO-RAs approved by the US Food and Drug Administration (FDA) for second-line treatment of ITP are avatrombopag, eltrombopag, and romiplostim. […] Given the safety and efficacy data, TPO-RAs are the preferred second-line treatment for patients with ITP. […] The ASH guideline panel conditionally recommends the following treatment options in adults with ITP lasting 3 months who are corticosteroid dependent or have no response to corticosteroids: Either splenectomy or a TPO-RA; TPO-RAs are recommended over rituximab; Rituximab is recommended over a splenectomy. […] The choice of treatment should be based on disease duration, frequency of bleeding episodes, the patients age, comorbidities, treatment preference regarding adverse effects, route of administration, cost, and effects on HRQOL.

• #45 Immune thrombocytopenia (ITP) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/idiopathic-thrombocytopenic-purpura/diagnosis-treatment/drc-20352330

  People with mild immune thrombocytopenia might need only regular platelet checks. […] Most adults with ITP will need treatment at some point. The condition often gets worse or lasts long, also known as chronic. […] Treatment might include medicines to increase platelet count or surgery to remove the spleen, known as a splenectomy. […] Some people find the side effects of treatment are worse than the disease. […] Medicines to treat ITP may include: […] Health care providers often use an oral corticosteroid, such as prednisone. […] If corticosteroids don’t work, a shot of immune globulin might help. […] Medicines such as romiplostim (Nplate), eltrombopag (Promacta) and avatrombopag (Doptelet) help bone marrow make more platelets. […] Rituximab (Rituxan, Ruxience, Truxima) helps increase the platelet count by reducing the immune system response damaging them.

• #46 Recent advances in treatments of adult immune thrombocytopenia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9057657/

  Most of ITP patients respond to primary treatment such as glucocorticoids or IVIG, but a significant number of patients eventually require secondary treatment because the maintain of long-term responses are difficult. Such patients may consider medical therapy (TPO-RA, rituximab) or surgical option (splenectomy). […] TPO-RAs are small molecule that stimulates thrombopoietin to increase the production of platelets by megakaryocytes in bone marrow. Currently, there are three agents (eltrombopag, romiplostim and avatrombopag) that have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of chronic ITP. […] Because B-cell plays an important role in pathogenesis of ITP, rituximab, chimeric monoclonal antibody against CD20 on the surface of B-lymphocyte has been proposed for many years to treatment of ITP.

• #47 Immune Thrombocytopenia | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/immune-thrombocytopenia

  If initial treatments are not effective, the following treatments can be tried: […] Rituximab („Rituxan”) An antibody specifically directed against the type of immune system cells that can produce antibodies against platelets. This therapy may require up to four weekly infusions. The response to treatment is usually seen in four to six weeks after the first infusion, although it can take longer. […] Thrombopoietin mimetics (Eltrombopag/”Promacta” and Romiplostim/”Nplate”) These medications increase the bone marrow production of platelets. The FDA recently approved them for use in patients who do not respond to steroids. They generally work well to increase the platelet count. […] Splenectomy Splenectomy is the surgical removal of the spleen, the location where most of the antibody-bound platelets are removed from the bloodstream. This can be an effective and permanent solution for patients with ITP, but they will be at risk for developing certain infections in the future.

• #48 Second-line therapies in immune thrombocytopenia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6142486/

  A meta-analysis of 5 randomized trials (467 nonsplenectomized adults) of rituximab vs corticosteroids, IVIG, and/or anti-D globulin demonstrated a platelet count of 100 109/L or higher at 6 months in 46.8% of those treated with rituximab vs 32.5% in the other medical therapy group (P = .002). […] Multiple other agents are used as second-line treatments for ITP, including mycophenolate mofetil, dapsone, sirolimus, vincristine, 6-mercaptopurine, azathioprine, and danazol.

• #49 Second-line therapies in immune thrombocytopenia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6142486/

  A meta-analysis of 5 randomized trials (467 nonsplenectomized adults) of rituximab vs corticosteroids, IVIG, and/or anti-D globulin demonstrated a platelet count of 100 109/L or higher at 6 months in 46.8% of those treated with rituximab vs 32.5% in the other medical therapy group (P = .002). […] Multiple other agents are used as second-line treatments for ITP, including mycophenolate mofetil, dapsone, sirolimus, vincristine, 6-mercaptopurine, azathioprine, and danazol.

• #50 Treatments | ITP Australia and New Zealand

  https://itpaustralia.org.au/treatments/

  ITP TREATMENTS […] Once a diagnosis of ITP has been reached there are a number of options for treatment. In Australia the individual needs and factors of the patient are taken into account when deciding on the course of action taken. This includes age, mobility and lifestyle. […] The initial treatment will normally include corticosteroids and/or IVIg followed by secondary treatments. These currently include Rituximab, TPORAs and more. […] Treatments and their effectiveness are as unique as each patient. […] What works for one patient may not work as effectively as another. […] Corticosteroids work by suppressing the immune system to raise the platelet count. Treatment is normally administered in the form of an oral tablet with the dosage determined by your medical professional. […] Intravenous Immunoglobin is also known as IVIg. IVIg is a solution of human donated plasma proteins and, in particular, IgG antibodies with a broad spectrum of antibody activities. […] Research indicates that Rituximab has a better response rate in patients that have had ITP for under two years. It has been shown that 50-60% of patients during this timeframe achieve a platelet count of >50 x 109/L. […] There are three TPORA treatments available in Australia. These treatments are available prior to splenectomy and include Romiplostim (NPlate), Eltrombopag (Revolade or Promacta) and Avatrombopag (Doptelet), which was added for use in Australia on 1 July 2023. […] Immunosuppressant medication can be used across various autoimmune diseases. It works by decreasing the body’s immune system. These medications include Mycophenolate mofetil (also known as MMF and CellCept), Azathioprine (also known as Imuran) and Cyclosporine. […] This is a surgical procedure which involves the removal of the spleen. Located underneath the ribcage on the left side, the spleen has several functions which include the filtration of germs and bacteria which may cause infection, storage for extra blood not needed and the removal of old or damaged blood cells, including platelets. […] Danazol, sold as Danocrine and other brand names, is a medication used in the treatment of conditions, including ITP. Danazol is a synthetic steroid and pituitary gonadotropin (a hormone made by a part of the brain called the hypothalamus) inhibitor. […] Hydroxychloroquine is in a class of drugs called antimalarials. It works by killing the organisms that cause malaria. Hydroxychloroquine may work to treat rheumatoid arthritis, systemic lupus erythematosus and ITP by decreasing the activity of the immune system. […] Dapsone, a sulfone, belongs to the family of medicines called anti-infectives. Dapsone can be used as a second-line treatment in ITP can is also used to treat leprosy (Hansen’s disease) and to help control dermatitis herpetiformis, a skin problem.

• #51 Second-Line Treatment of Persistent Immune Thrombocytopenia – Hematology Advisor

  https://www.hematologyadvisor.com/cch/second-line-treatment-persistent-immune-thrombocytopenia/

  TPO-RAs are currently the only therapy specifically developed to treat ITP. […] The TPO-RAs approved by the US Food and Drug Administration (FDA) for second-line treatment of ITP are avatrombopag, eltrombopag, and romiplostim. […] Given the safety and efficacy data, TPO-RAs are the preferred second-line treatment for patients with ITP. […] The ASH guideline panel conditionally recommends the following treatment options in adults with ITP lasting 3 months who are corticosteroid dependent or have no response to corticosteroids: Either splenectomy or a TPO-RA; TPO-RAs are recommended over rituximab; Rituximab is recommended over a splenectomy. […] The choice of treatment should be based on disease duration, frequency of bleeding episodes, the patients age, comorbidities, treatment preference regarding adverse effects, route of administration, cost, and effects on HRQOL.

• #52 Immune thrombocytopenia (ITP) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/idiopathic-thrombocytopenic-purpura/diagnosis-treatment/drc-20352330

  Fostamatinib (Tavalisse) is a newer drug approved for people with long-lasting ITP who haven’t responded to other treatments. […] If medicine doesn’t make ITP better, surgery to remove the spleen might be the next step. […] When it works, this surgery quickly ends the attacks on platelets and improves platelet count. […] Emergency care usually includes getting blood, also known as transfusion, that contains many platelets.

• #53 Immune Thrombocytopenia (ITP) Treatment & Management: Approach Considerations, Thrombopoietin Receptor Agonists, Treatment in Children

  https://emedicine.medscape.com/article/202158-treatment

  The ASH recommends that if treatment is needed, shorter courses of corticosteroids (6 weeks) are preferred over prolonged courses as first-line treatment. […] In adults with ITP lasting 3 months who are corticosteroid-dependent or have no response to corticosteroids, the ASH guidelines suggest either splenectomy or a TPO-RA. […] Fostamatinib (Tavalisse) was approved by the US Food and Drug Administration (FDA) in 2018 for thrombocytopenia in adults with chronic ITP who have had an insufficient response to a previous treatment. […] Pregnant women with no bleeding manifestations whose platelet counts are 30 109/L or higher do not require any treatment until 36 weeks’ gestation, unless delivery is imminent. […] Refractory ITP in pregnancy can be treated with corticosteroids and IVIG in combination, or splenectomy (in the second trimester). […] In persons with acute immune thrombocytopenia (ITP), splenectomy usually results in rapid, complete, and life-long clinical remission. […] If 6 months of medical management fails to increase the platelet count to a safe range (about 30,000/L), splenectomy becomes an option.

• #54 Recent advances in treatments of adult immune thrombocytopenia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9057657/

  Splenectomy is an effective treatment as the spleen is the major site of platelet destruction as well as a site of anti-platelet antibody production. […] Although current treatments of ITP have shown significant responses, some patients have no response to treatment or failed to achieve long-term remission. Recent advances in understanding of ITP pathophysiology have suggested various mechanisms for ITP development. Current evidence suggests that thrombocytopenia in ITP is the result of multiple mechanisms, including impaired thrombopoiesis and variations in immune response leading to platelet destruction. Recently, various novel treatments targeting these pathways are being developed. […] Fostamatinib is an oral tyrosine kinase inhibitor that blocks splenic tyrosine kinase (SYK) and is a drug approved by the U.S. FDA for ITP patients who have failed first-or second-line therapy, or intolerable to these therapies.

• #55

  https://link.springer.com/article/10.1007/s44337-024-00008-8

  In 2009, an International Working Group (IWG) standardized the term idiopathic by using immune instead, to emphasize the immune-mediated mechanism of the disease. […] Thrombopoietin-receptor agonists increased platelet counts by boosting platelet production in a dose-dependent manner. […] The overall response rate is 88 percent. Mean time to respond is 13.8 weeks. […] Eltrombopag, an oral thrombopoietin-receptor agonist, also showed similar responses with response rate between 70 to 81 percent. […] The mechanism is to interfere with phagocyte Fc-receptor-mediated immune clearance and acceleration of antiplatelet antibody elimination. […] A regimen of 1 g per kg per day for two days will increase the platelet count in most patients within 3 days. […] The mechanism involves inhibiting Syk activation in splenic macrophages. […] Fostamatinib, given orally at 100 mg twice daily for 24 weeks, showed an overall response rate of 43 percent in chronic ITP patients compared with 14 percent in the placebo group.

• #56

  https://link.springer.com/article/10.1007/s44337-024-00008-8

  In 2009, an International Working Group (IWG) standardized the term idiopathic by using immune instead, to emphasize the immune-mediated mechanism of the disease. […] Thrombopoietin-receptor agonists increased platelet counts by boosting platelet production in a dose-dependent manner. […] The overall response rate is 88 percent. Mean time to respond is 13.8 weeks. […] Eltrombopag, an oral thrombopoietin-receptor agonist, also showed similar responses with response rate between 70 to 81 percent. […] The mechanism is to interfere with phagocyte Fc-receptor-mediated immune clearance and acceleration of antiplatelet antibody elimination. […] A regimen of 1 g per kg per day for two days will increase the platelet count in most patients within 3 days. […] The mechanism involves inhibiting Syk activation in splenic macrophages. […] Fostamatinib, given orally at 100 mg twice daily for 24 weeks, showed an overall response rate of 43 percent in chronic ITP patients compared with 14 percent in the placebo group.

• #57 Recommendations for the Clinical Approach to Immune Thrombocytopenia: Spanish ITP Working Group (GEPTI)

  https://www.mdpi.com/2077-0383/12/20/6422

  Other therapeutic options have been suggested, although the experience reported so far does not allow us to consider them as being on the same level as those mentioned above. […] The aim of the treatment should focus on the control of clinically relevant hemorrhages rather than the platelet count recovery. […] The first choice should be TPO-RA (eltrombopag, romiplostim, avatrombopag) or fostamatinib. […] Fostamatinib is another option for second-line treatment in ITP. […] Rituximab is a monoclonal antibody targeting the B-cell surface receptor CD20. […] Splenectomy can be considered in chronic phases after at least one second-line treatment has failed. […] The use of immunosuppressants such as azathioprine, cyclosporine or mycophenolate mofetil, immunomodulators such as danazol or dapsone, or cytostatic agents such as cyclophosphamide or vinca alkaloids (vincristine, vinblastine) can also be envisaged.

• #58 Recent advances in treatments of adult immune thrombocytopenia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9057657/

  Splenectomy is an effective treatment as the spleen is the major site of platelet destruction as well as a site of anti-platelet antibody production. […] Although current treatments of ITP have shown significant responses, some patients have no response to treatment or failed to achieve long-term remission. Recent advances in understanding of ITP pathophysiology have suggested various mechanisms for ITP development. Current evidence suggests that thrombocytopenia in ITP is the result of multiple mechanisms, including impaired thrombopoiesis and variations in immune response leading to platelet destruction. Recently, various novel treatments targeting these pathways are being developed. […] Fostamatinib is an oral tyrosine kinase inhibitor that blocks splenic tyrosine kinase (SYK) and is a drug approved by the U.S. FDA for ITP patients who have failed first-or second-line therapy, or intolerable to these therapies.

• #59 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  Thrombopoietic agents functioning by stimulating platelet production have significantly changed the management of ITP. […] Splenectomy remains the most effective therapy for corticosteroid-resistant or relapsed ITP patients by removing the major site of platelet phagocytosis and autoantibody production. […] The necessity for antibiotic prophylaxis in splenectomized ITP patients is still undetermined, and we suggest antibiotic prophylaxis in high-risk patients, such as immunocompromised cases, or those with a poor response to vaccination. […] The emergence of novel agents targeting different pathogenetic mechanisms of ITP has deeply modified the second-line treatment modalities, which have gradually shifted away from immune suppression.

• #60 Pediatric immune thrombocytopenia (ITP) treatment – Kim – Annals of Blood

  https://aob.amegroups.org/article/view/6316/html

  Romiplostim was approved in December 2018 for use in children over 1 year of age who had refractory disease persisting beyond 6 months. […] Though not FDA approved for use in ITP, based on experience with other autoimmune conditions, rituximab has long been used for patients with ITP and inadequate response to upfront therapy. […] In the past, splenectomy was a commonly utilized second line treatment, but is now rarely performed. […] Pediatric response rates to splenectomy are around 60-70% within a day of surgery, hence its application in the case of life-threatening bleeding. […] After first- and second-line therapies have been tried, the next therapy option is selected in discussions between the medical team, caregivers and patient. […] There is a paucity of large, formal studies evaluating outcomes of third line agents in pediatric ITP and certainly, there are no randomized controlled trials comparing the many available therapies directly. […] The genetic and molecular understanding of ITP pathogenesis is expanding. […] A number of newer agents are being employed for adult ITP management which may eventually have utility in pediatric populations.

• #61 Second-Line Treatment of Persistent Immune Thrombocytopenia – Hematology Advisor

  https://www.hematologyadvisor.com/cch/second-line-treatment-persistent-immune-thrombocytopenia/

  Although first-line treatments provide a rapid platelet response, the response is typically lasts less than 6 months. […] To prevent the misuse of corticosteroids and improve long-term clinical outcomes, patients should switch from treatment with corticosteroids to alternative options earlier in the course of treatment. […] Consequently, second-line treatments are needed to achieve more durable responses. […] The current treatment options used in the second-line setting include thrombopoietin receptor agonists (TPO-RAs), splenectomy, rituximab. […] The goal of splenectomy is to stop platelet destruction. […] Splenectomy offers a higher durable response rate of 77% compared with other ITP therapies. […] Rituximab is a therapeutic candidate for second-line treatment of ITP in patients with suboptimal responses to first-line therapy.

• #62 Immune Thrombocytopenia (ITP) Treatment & Management: Approach Considerations, Thrombopoietin Receptor Agonists, Treatment in Children

  https://emedicine.medscape.com/article/202158-treatment

  The ASH recommends that if treatment is needed, shorter courses of corticosteroids (6 weeks) are preferred over prolonged courses as first-line treatment. […] In adults with ITP lasting 3 months who are corticosteroid-dependent or have no response to corticosteroids, the ASH guidelines suggest either splenectomy or a TPO-RA. […] Fostamatinib (Tavalisse) was approved by the US Food and Drug Administration (FDA) in 2018 for thrombocytopenia in adults with chronic ITP who have had an insufficient response to a previous treatment. […] Pregnant women with no bleeding manifestations whose platelet counts are 30 109/L or higher do not require any treatment until 36 weeks’ gestation, unless delivery is imminent. […] Refractory ITP in pregnancy can be treated with corticosteroids and IVIG in combination, or splenectomy (in the second trimester). […] In persons with acute immune thrombocytopenia (ITP), splenectomy usually results in rapid, complete, and life-long clinical remission. […] If 6 months of medical management fails to increase the platelet count to a safe range (about 30,000/L), splenectomy becomes an option.

• #63

  https://haematologica.org/article/view/haematol.2021.279513

  Another option for second-line therapy would be a thrombopoietin receptor agonist (TPO-RA). […] Fostamatinib is a first-in-class, orally active spleen tyrosine kinase (Syk) inhibitor indicated for the treatment of ITP. […] The American Society of Hematology guidelines and international consensus report recommend that splenectomy be delayed to at least 1 year after the diagnosis of ITP, since the rate of resolution of ITP within the first 1-3 years of disease appears substantial even in adults. […] As this woman could not taper her prednisone successfully, still had bleeding, and had a platelet count 20×109/L, she met the criteria to receive a second-line treatment. […] In summary, according to three reports of the use of three different thrombopoietin agents in pregnancy, these drugs appear to be safe as a class with no information available for avatrombopag, very limited information for eltrombopag, and considerable safety but little efficacy information for romiplostim.

• #64 How we treat primary immune thrombocytopenia in adults | Journal of Hematology & Oncology | Full Text

  https://jhoonline.biomedcentral.com/articles/10.1186/s13045-023-01401-z

  Thrombopoietic agents functioning by stimulating platelet production have significantly changed the management of ITP. […] Splenectomy remains the most effective therapy for corticosteroid-resistant or relapsed ITP patients by removing the major site of platelet phagocytosis and autoantibody production. […] The necessity for antibiotic prophylaxis in splenectomized ITP patients is still undetermined, and we suggest antibiotic prophylaxis in high-risk patients, such as immunocompromised cases, or those with a poor response to vaccination. […] The emergence of novel agents targeting different pathogenetic mechanisms of ITP has deeply modified the second-line treatment modalities, which have gradually shifted away from immune suppression.

• #65 What Is Immune Thrombocytopenia (ITP): Symptoms, Causes, Diagnosis, Treatment, and Prevention | Everyday Health

  https://www.everydayhealth.com/immune-thrombocytopenia/guide/

  There is no cure for ITP, but there are effective ways to manage it. One of these strategies is to use medication. These may include: […] Oral Corticosteroids Drugs of this type, such as prednisone (Deltasone), dexamethasone (Decadron), or methylprednisolone (Medrol), are usually the first line of treatment for ITP. […] Immune Globulin If your body doesn’t respond to corticosteroids, your doctor may recommend immune globulin. […] Drugs to Raise Platelet Count Certain medication can boost platelet production, including romiplostim (Nplate), eltrombopag (Promacta), and rituximab (Rituxan). […] In severe cases of ITP or when there is little response to medication therapy, surgery to remove the spleen may be needed. This procedure is called a splenectomy. […] However, there are risks associated with this procedure, as not having a spleen can increase the chance of infection, according to the Cleveland Clinic. […] If you and your doctor decide a splenectomy is the best course of action, you may be given vaccines before the procedure to prevent infection.

• #66 The treatment of immune thrombocytopenia (ITP)—focus on thrombopoietin receptor agonists – Kuter – Annals of Blood

  https://aob.amegroups.org/article/view/6335/html

  For those failing TPO-RA or not able to receive it, there are a number of other medical options. […] Fostamatinib is a newer agent with a unique mechanism of action. It inhibits syk kinase thereby reducing macrophage destruction of platelets. […] Mycophenolate mofetil is a useful agent in ITP but has not been well studied until recently. […] Dapsone has a long history of use in chronic ITP. It is yet another steroid sparing option in responsive ITP patients. […] Danazol is another steroid sparing medication like dapsone and MMF which is helpful in some ITP patients. […] In refractory patients, we will always reassess the need for therapy. Many patients can live a reasonably normal life at platelet counts under 20,000/L with only occasional need for corticosteroids or antifibrinolytic agents. […] A large number of very promising new ITP treatments (Bruton kinase inhibitors, neonatal Fc receptor inhibitors, anti-CD 38 antibodies) are being developed and patients should be offered access to these trials.

• #67 Second-line therapies in immune thrombocytopenia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6142486/

  A meta-analysis of 5 randomized trials (467 nonsplenectomized adults) of rituximab vs corticosteroids, IVIG, and/or anti-D globulin demonstrated a platelet count of 100 109/L or higher at 6 months in 46.8% of those treated with rituximab vs 32.5% in the other medical therapy group (P = .002). […] Multiple other agents are used as second-line treatments for ITP, including mycophenolate mofetil, dapsone, sirolimus, vincristine, 6-mercaptopurine, azathioprine, and danazol.

• #68 Protocol for the study and treatment of primary immune thrombocytopenia: ITP-2018 | Anales de Pediatría

  https://www.analesdepediatria.org/en-protocol-for-study-treatment-primary-articulo-S2341287919301152

  Corticosteroids are historically the first-line treatment of primary ITP. […] The thrombopoietin analogues, eltrombopag and romiplostim, are two molecules with different characteristics that induce thrombopoiesis through the stimulation of their respective receptors. They have been developed in recent years and clinical trials have demonstrated that they can achieve a sustained response in a high percentage of cases in which treatment with other drugs (steroid therapy, IVIG) fails or does not achieve a sustained response off therapy. […] Treatment with thrombopoietin receptor agonists should be prescribed and managed in paediatric haematology units. […] Rituximab has been used in adults and also children, although there are fewer published data for the paediatric age group. […] Mycophenolate mofetil may be effective in patients with less severe forms of chronic ITP or patients with autoimmune cytopenias. […] There are limited data on its use for treatment of primary ITP in the paediatric population.

• #69 Immune Thrombocytopenia (ITP) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/immune-thrombocytopenia-itp

  Treatment options for ITP […] Steroids temporarily calm the immune system to slow the rate at which platelets are destroyed. […] Intravenous immunoglobulin (IVIG), also known as intravenous gamma globulin: IVIG contains antibodies that help slow the rate at which platelets are destroyed. […] Thrombopoietin (TPO) receptor agonists: This family of medications increases platelet production. […] Rituximab calms the immune attack on platelets by suppressing B cells, the white blood cells that produce antibodies. […] Mycophenolate and sirolimus: These oral medications help prevent attacks on platelets by inhibiting activity of white blood cells called lymphocytes (B and T cells). […] Hydroxychloroquine is sometimes prescribed if ITP is accompanied by other autoimmune disorders. […] Other treatments: As needed, our team may offer hormone therapy if patients have heavy menstrual bleeding and anti-fibrinolytic medications (aminocaproic acid, tranexamic acid) to reduce nosebleeds, gum bleeding, or heavy menstrual bleeding.

• #70 Second-line therapies in immune thrombocytopenia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6142486/

  A meta-analysis of 5 randomized trials (467 nonsplenectomized adults) of rituximab vs corticosteroids, IVIG, and/or anti-D globulin demonstrated a platelet count of 100 109/L or higher at 6 months in 46.8% of those treated with rituximab vs 32.5% in the other medical therapy group (P = .002). […] Multiple other agents are used as second-line treatments for ITP, including mycophenolate mofetil, dapsone, sirolimus, vincristine, 6-mercaptopurine, azathioprine, and danazol.

• #71 Treatments | ITP Australia and New Zealand

  https://itpaustralia.org.au/treatments/

  ITP TREATMENTS […] Once a diagnosis of ITP has been reached there are a number of options for treatment. In Australia the individual needs and factors of the patient are taken into account when deciding on the course of action taken. This includes age, mobility and lifestyle. […] The initial treatment will normally include corticosteroids and/or IVIg followed by secondary treatments. These currently include Rituximab, TPORAs and more. […] Treatments and their effectiveness are as unique as each patient. […] What works for one patient may not work as effectively as another. […] Corticosteroids work by suppressing the immune system to raise the platelet count. Treatment is normally administered in the form of an oral tablet with the dosage determined by your medical professional. […] Intravenous Immunoglobin is also known as IVIg. IVIg is a solution of human donated plasma proteins and, in particular, IgG antibodies with a broad spectrum of antibody activities. […] Research indicates that Rituximab has a better response rate in patients that have had ITP for under two years. It has been shown that 50-60% of patients during this timeframe achieve a platelet count of >50 x 109/L. […] There are three TPORA treatments available in Australia. These treatments are available prior to splenectomy and include Romiplostim (NPlate), Eltrombopag (Revolade or Promacta) and Avatrombopag (Doptelet), which was added for use in Australia on 1 July 2023. […] Immunosuppressant medication can be used across various autoimmune diseases. It works by decreasing the body’s immune system. These medications include Mycophenolate mofetil (also known as MMF and CellCept), Azathioprine (also known as Imuran) and Cyclosporine. […] This is a surgical procedure which involves the removal of the spleen. Located underneath the ribcage on the left side, the spleen has several functions which include the filtration of germs and bacteria which may cause infection, storage for extra blood not needed and the removal of old or damaged blood cells, including platelets. […] Danazol, sold as Danocrine and other brand names, is a medication used in the treatment of conditions, including ITP. Danazol is a synthetic steroid and pituitary gonadotropin (a hormone made by a part of the brain called the hypothalamus) inhibitor. […] Hydroxychloroquine is in a class of drugs called antimalarials. It works by killing the organisms that cause malaria. Hydroxychloroquine may work to treat rheumatoid arthritis, systemic lupus erythematosus and ITP by decreasing the activity of the immune system. […] Dapsone, a sulfone, belongs to the family of medicines called anti-infectives. Dapsone can be used as a second-line treatment in ITP can is also used to treat leprosy (Hansen’s disease) and to help control dermatitis herpetiformis, a skin problem.

• #72 Recommendations for the Clinical Approach to Immune Thrombocytopenia: Spanish ITP Working Group (GEPTI)

  https://www.mdpi.com/2077-0383/12/20/6422

  Other therapeutic options have been suggested, although the experience reported so far does not allow us to consider them as being on the same level as those mentioned above. […] The aim of the treatment should focus on the control of clinically relevant hemorrhages rather than the platelet count recovery. […] The first choice should be TPO-RA (eltrombopag, romiplostim, avatrombopag) or fostamatinib. […] Fostamatinib is another option for second-line treatment in ITP. […] Rituximab is a monoclonal antibody targeting the B-cell surface receptor CD20. […] Splenectomy can be considered in chronic phases after at least one second-line treatment has failed. […] The use of immunosuppressants such as azathioprine, cyclosporine or mycophenolate mofetil, immunomodulators such as danazol or dapsone, or cytostatic agents such as cyclophosphamide or vinca alkaloids (vincristine, vinblastine) can also be envisaged.

• #73 Treatments | ITP Australia and New Zealand

  https://itpaustralia.org.au/treatments/

  ITP TREATMENTS […] Once a diagnosis of ITP has been reached there are a number of options for treatment. In Australia the individual needs and factors of the patient are taken into account when deciding on the course of action taken. This includes age, mobility and lifestyle. […] The initial treatment will normally include corticosteroids and/or IVIg followed by secondary treatments. These currently include Rituximab, TPORAs and more. […] Treatments and their effectiveness are as unique as each patient. […] What works for one patient may not work as effectively as another. […] Corticosteroids work by suppressing the immune system to raise the platelet count. Treatment is normally administered in the form of an oral tablet with the dosage determined by your medical professional. […] Intravenous Immunoglobin is also known as IVIg. IVIg is a solution of human donated plasma proteins and, in particular, IgG antibodies with a broad spectrum of antibody activities. […] Research indicates that Rituximab has a better response rate in patients that have had ITP for under two years. It has been shown that 50-60% of patients during this timeframe achieve a platelet count of >50 x 109/L. […] There are three TPORA treatments available in Australia. These treatments are available prior to splenectomy and include Romiplostim (NPlate), Eltrombopag (Revolade or Promacta) and Avatrombopag (Doptelet), which was added for use in Australia on 1 July 2023. […] Immunosuppressant medication can be used across various autoimmune diseases. It works by decreasing the body’s immune system. These medications include Mycophenolate mofetil (also known as MMF and CellCept), Azathioprine (also known as Imuran) and Cyclosporine. […] This is a surgical procedure which involves the removal of the spleen. Located underneath the ribcage on the left side, the spleen has several functions which include the filtration of germs and bacteria which may cause infection, storage for extra blood not needed and the removal of old or damaged blood cells, including platelets. […] Danazol, sold as Danocrine and other brand names, is a medication used in the treatment of conditions, including ITP. Danazol is a synthetic steroid and pituitary gonadotropin (a hormone made by a part of the brain called the hypothalamus) inhibitor. […] Hydroxychloroquine is in a class of drugs called antimalarials. It works by killing the organisms that cause malaria. Hydroxychloroquine may work to treat rheumatoid arthritis, systemic lupus erythematosus and ITP by decreasing the activity of the immune system. […] Dapsone, a sulfone, belongs to the family of medicines called anti-infectives. Dapsone can be used as a second-line treatment in ITP can is also used to treat leprosy (Hansen’s disease) and to help control dermatitis herpetiformis, a skin problem.

• #74 Recommendations for the Clinical Approach to Immune Thrombocytopenia: Spanish ITP Working Group (GEPTI)

  https://www.mdpi.com/2077-0383/12/20/6422

  Other therapeutic options have been suggested, although the experience reported so far does not allow us to consider them as being on the same level as those mentioned above. […] The aim of the treatment should focus on the control of clinically relevant hemorrhages rather than the platelet count recovery. […] The first choice should be TPO-RA (eltrombopag, romiplostim, avatrombopag) or fostamatinib. […] Fostamatinib is another option for second-line treatment in ITP. […] Rituximab is a monoclonal antibody targeting the B-cell surface receptor CD20. […] Splenectomy can be considered in chronic phases after at least one second-line treatment has failed. […] The use of immunosuppressants such as azathioprine, cyclosporine or mycophenolate mofetil, immunomodulators such as danazol or dapsone, or cytostatic agents such as cyclophosphamide or vinca alkaloids (vincristine, vinblastine) can also be envisaged.

• #75 The treatment of immune thrombocytopenia (ITP)—focus on thrombopoietin receptor agonists – Kuter – Annals of Blood

  https://aob.amegroups.org/article/view/6335/html

  For those failing TPO-RA or not able to receive it, there are a number of other medical options. […] Fostamatinib is a newer agent with a unique mechanism of action. It inhibits syk kinase thereby reducing macrophage destruction of platelets. […] Mycophenolate mofetil is a useful agent in ITP but has not been well studied until recently. […] Dapsone has a long history of use in chronic ITP. It is yet another steroid sparing option in responsive ITP patients. […] Danazol is another steroid sparing medication like dapsone and MMF which is helpful in some ITP patients. […] In refractory patients, we will always reassess the need for therapy. Many patients can live a reasonably normal life at platelet counts under 20,000/L with only occasional need for corticosteroids or antifibrinolytic agents. […] A large number of very promising new ITP treatments (Bruton kinase inhibitors, neonatal Fc receptor inhibitors, anti-CD 38 antibodies) are being developed and patients should be offered access to these trials.

• #76 Second-line therapies in immune thrombocytopenia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6142486/

  The thrombopoietin receptor agonists (TPO-RAs) bind to and stimulate the TPO receptor and increase platelet production. […] Eltrombopag is also approved for children older than 1 year who have chronic ITP. […] Randomized trials in children and adults have demonstrated an initial platelet response with eltrombopag of 59% to 75%, and a durable response with continued treatment of 62%. […] A study of 21 refractory patients reported a response rate of 53% with a platelet count higher than 50 109/L within 12 weeks of initiation and with continued response up to a median of 24 weeks. […] A review of published case series in children and adults with ITP reports an overall platelet response to dapsone of 40% to 62%. […] Splenectomy is the most predictable method for achieving a durable remission.

• #77 The treatment of immune thrombocytopenia (ITP)—focus on thrombopoietin receptor agonists – Kuter – Annals of Blood

  https://aob.amegroups.org/article/view/6335/html

  For those failing TPO-RA or not able to receive it, there are a number of other medical options. […] Fostamatinib is a newer agent with a unique mechanism of action. It inhibits syk kinase thereby reducing macrophage destruction of platelets. […] Mycophenolate mofetil is a useful agent in ITP but has not been well studied until recently. […] Dapsone has a long history of use in chronic ITP. It is yet another steroid sparing option in responsive ITP patients. […] Danazol is another steroid sparing medication like dapsone and MMF which is helpful in some ITP patients. […] In refractory patients, we will always reassess the need for therapy. Many patients can live a reasonably normal life at platelet counts under 20,000/L with only occasional need for corticosteroids or antifibrinolytic agents. […] A large number of very promising new ITP treatments (Bruton kinase inhibitors, neonatal Fc receptor inhibitors, anti-CD 38 antibodies) are being developed and patients should be offered access to these trials.

• #78 The treatment of immune thrombocytopenia (ITP)—focus on thrombopoietin receptor agonists – Kuter – Annals of Blood

  https://aob.amegroups.org/article/view/6335/html

  For those failing TPO-RA or not able to receive it, there are a number of other medical options. […] Fostamatinib is a newer agent with a unique mechanism of action. It inhibits syk kinase thereby reducing macrophage destruction of platelets. […] Mycophenolate mofetil is a useful agent in ITP but has not been well studied until recently. […] Dapsone has a long history of use in chronic ITP. It is yet another steroid sparing option in responsive ITP patients. […] Danazol is another steroid sparing medication like dapsone and MMF which is helpful in some ITP patients. […] In refractory patients, we will always reassess the need for therapy. Many patients can live a reasonably normal life at platelet counts under 20,000/L with only occasional need for corticosteroids or antifibrinolytic agents. […] A large number of very promising new ITP treatments (Bruton kinase inhibitors, neonatal Fc receptor inhibitors, anti-CD 38 antibodies) are being developed and patients should be offered access to these trials.

• #79 Treatments | ITP Australia and New Zealand

  https://itpaustralia.org.au/treatments/

  ITP TREATMENTS […] Once a diagnosis of ITP has been reached there are a number of options for treatment. In Australia the individual needs and factors of the patient are taken into account when deciding on the course of action taken. This includes age, mobility and lifestyle. […] The initial treatment will normally include corticosteroids and/or IVIg followed by secondary treatments. These currently include Rituximab, TPORAs and more. […] Treatments and their effectiveness are as unique as each patient. […] What works for one patient may not work as effectively as another. […] Corticosteroids work by suppressing the immune system to raise the platelet count. Treatment is normally administered in the form of an oral tablet with the dosage determined by your medical professional. […] Intravenous Immunoglobin is also known as IVIg. IVIg is a solution of human donated plasma proteins and, in particular, IgG antibodies with a broad spectrum of antibody activities. […] Research indicates that Rituximab has a better response rate in patients that have had ITP for under two years. It has been shown that 50-60% of patients during this timeframe achieve a platelet count of >50 x 109/L. […] There are three TPORA treatments available in Australia. These treatments are available prior to splenectomy and include Romiplostim (NPlate), Eltrombopag (Revolade or Promacta) and Avatrombopag (Doptelet), which was added for use in Australia on 1 July 2023. […] Immunosuppressant medication can be used across various autoimmune diseases. It works by decreasing the body’s immune system. These medications include Mycophenolate mofetil (also known as MMF and CellCept), Azathioprine (also known as Imuran) and Cyclosporine. […] This is a surgical procedure which involves the removal of the spleen. Located underneath the ribcage on the left side, the spleen has several functions which include the filtration of germs and bacteria which may cause infection, storage for extra blood not needed and the removal of old or damaged blood cells, including platelets. […] Danazol, sold as Danocrine and other brand names, is a medication used in the treatment of conditions, including ITP. Danazol is a synthetic steroid and pituitary gonadotropin (a hormone made by a part of the brain called the hypothalamus) inhibitor. […] Hydroxychloroquine is in a class of drugs called antimalarials. It works by killing the organisms that cause malaria. Hydroxychloroquine may work to treat rheumatoid arthritis, systemic lupus erythematosus and ITP by decreasing the activity of the immune system. […] Dapsone, a sulfone, belongs to the family of medicines called anti-infectives. Dapsone can be used as a second-line treatment in ITP can is also used to treat leprosy (Hansen’s disease) and to help control dermatitis herpetiformis, a skin problem.

• #80 Immune Thrombocytopenia (ITP) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/immune-thrombocytopenia-itp

  Treatment options for ITP […] Steroids temporarily calm the immune system to slow the rate at which platelets are destroyed. […] Intravenous immunoglobulin (IVIG), also known as intravenous gamma globulin: IVIG contains antibodies that help slow the rate at which platelets are destroyed. […] Thrombopoietin (TPO) receptor agonists: This family of medications increases platelet production. […] Rituximab calms the immune attack on platelets by suppressing B cells, the white blood cells that produce antibodies. […] Mycophenolate and sirolimus: These oral medications help prevent attacks on platelets by inhibiting activity of white blood cells called lymphocytes (B and T cells). […] Hydroxychloroquine is sometimes prescribed if ITP is accompanied by other autoimmune disorders. […] Other treatments: As needed, our team may offer hormone therapy if patients have heavy menstrual bleeding and anti-fibrinolytic medications (aminocaproic acid, tranexamic acid) to reduce nosebleeds, gum bleeding, or heavy menstrual bleeding.

• #81 Treatments | ITP Australia and New Zealand

  https://itpaustralia.org.au/treatments/

  ITP TREATMENTS […] Once a diagnosis of ITP has been reached there are a number of options for treatment. In Australia the individual needs and factors of the patient are taken into account when deciding on the course of action taken. This includes age, mobility and lifestyle. […] The initial treatment will normally include corticosteroids and/or IVIg followed by secondary treatments. These currently include Rituximab, TPORAs and more. […] Treatments and their effectiveness are as unique as each patient. […] What works for one patient may not work as effectively as another. […] Corticosteroids work by suppressing the immune system to raise the platelet count. Treatment is normally administered in the form of an oral tablet with the dosage determined by your medical professional. […] Intravenous Immunoglobin is also known as IVIg. IVIg is a solution of human donated plasma proteins and, in particular, IgG antibodies with a broad spectrum of antibody activities. […] Research indicates that Rituximab has a better response rate in patients that have had ITP for under two years. It has been shown that 50-60% of patients during this timeframe achieve a platelet count of >50 x 109/L. […] There are three TPORA treatments available in Australia. These treatments are available prior to splenectomy and include Romiplostim (NPlate), Eltrombopag (Revolade or Promacta) and Avatrombopag (Doptelet), which was added for use in Australia on 1 July 2023. […] Immunosuppressant medication can be used across various autoimmune diseases. It works by decreasing the body’s immune system. These medications include Mycophenolate mofetil (also known as MMF and CellCept), Azathioprine (also known as Imuran) and Cyclosporine. […] This is a surgical procedure which involves the removal of the spleen. Located underneath the ribcage on the left side, the spleen has several functions which include the filtration of germs and bacteria which may cause infection, storage for extra blood not needed and the removal of old or damaged blood cells, including platelets. […] Danazol, sold as Danocrine and other brand names, is a medication used in the treatment of conditions, including ITP. Danazol is a synthetic steroid and pituitary gonadotropin (a hormone made by a part of the brain called the hypothalamus) inhibitor. […] Hydroxychloroquine is in a class of drugs called antimalarials. It works by killing the organisms that cause malaria. Hydroxychloroquine may work to treat rheumatoid arthritis, systemic lupus erythematosus and ITP by decreasing the activity of the immune system. […] Dapsone, a sulfone, belongs to the family of medicines called anti-infectives. Dapsone can be used as a second-line treatment in ITP can is also used to treat leprosy (Hansen’s disease) and to help control dermatitis herpetiformis, a skin problem.

• #82 Immune Thrombocytopenia (ITP) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/immune-thrombocytopenia-itp

  Treatment options for ITP […] Steroids temporarily calm the immune system to slow the rate at which platelets are destroyed. […] Intravenous immunoglobulin (IVIG), also known as intravenous gamma globulin: IVIG contains antibodies that help slow the rate at which platelets are destroyed. […] Thrombopoietin (TPO) receptor agonists: This family of medications increases platelet production. […] Rituximab calms the immune attack on platelets by suppressing B cells, the white blood cells that produce antibodies. […] Mycophenolate and sirolimus: These oral medications help prevent attacks on platelets by inhibiting activity of white blood cells called lymphocytes (B and T cells). […] Hydroxychloroquine is sometimes prescribed if ITP is accompanied by other autoimmune disorders. […] Other treatments: As needed, our team may offer hormone therapy if patients have heavy menstrual bleeding and anti-fibrinolytic medications (aminocaproic acid, tranexamic acid) to reduce nosebleeds, gum bleeding, or heavy menstrual bleeding.

• #83 ITP in Adults | ITP Support Association

  https://itpsupport.org.uk/itp-in-adults/

  What is the treatment? […] Treatments, which are currently aimed at suppressing or confusing the immune system, all have their dangers and drawbacks, only temporarily raise the platelet count, but do not cure the disease. […] Some adults with mild ITP may not need any treatment, but will be monitored with occasional blood tests. There is no cure for ITP and treatment is used to raise the platelet count to counteract symptoms. […] First line treatments include prednisolone and intravenous immunoglobulin (under various brand names). […] Second line treatments include splenectomy, azathioprine, cyclosporin, cyclophosphamide, vinca alkaloids, danazol, dapsone, rituximab, eltrombopag, romiplostim and mycophenolate mofetil. […] Tranexamic acid may be used for dental extractions. Hormone preparations and/or tranexamic acid may be prescribed to women having heavy periods. […] Platelet transfusions may be used to stem active bleeding or during surgery, but they are ineffective as a treatment for ITP as the immune system destroys transfused platelets as quickly as the body’s own platelets.

• #84 Immune Thrombocytopenia (ITP) – Hematology and Oncology – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hematology-and-oncology/thrombocytopenia-and-platelet-dysfunction/immune-thrombocytopenia-itp

  Patients with ITP and life-threatening bleeding are also given platelet transfusions. […] Treatment of children with immune thrombocytopenia is usually supportive because most children spontaneously recover. […] If mucosal bleeding occurs, corticosteroids or IVIG may be given. […] However, if thrombocytopenia is severe and symptomatic for 6 months, then TPO-RA (eg, romiplostim, eltrombopag) should be considered.

• #85 Immune Thrombocytopenia (ITP) – Together by St. Jude™

  https://together.stjude.org/en-us/conditions/blood-disorders/immune-thrombocytopenia-itp.html

  Other medications may be used to suppress the immune system. […] Surgery to remove the spleen (splenectomy) can help some children with chronic ITP who have low platelets. […] Platelet transfusions may be given if there is life-threatening bleeding or before a surgery or a procedure. In a platelet transfusion, donor platelets are given into a vein by IV.

• #86 Immune thrombocytopenia – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/138

  Immune thrombocytopenia (ITP) in children typically presents with a preceding viral illness and an abrupt onset. […] Treatment is based on platelet count and bleeding symptoms. Patients with life-threatening bleeding, regardless of platelet count, can be considered for combination therapy with corticosteroids, intravenous immunoglobulin (IVIG), and platelet transfusion. […] Initial treatment options for newly diagnosed ITP include observation, or a corticosteroid and/or IVIG depending on platelet count and bleeding symptoms. […] Subsequent treatment with thrombopoietin receptor agonists, rituximab, or fostamatinib (adults only) can be considered in patients who are unresponsive to, or intolerant of, initial treatment. […] Salvage therapy with oral immunosuppressants, such as mycophenolate, azathioprine, or dapsone, can be considered in patients who do not respond to multiple subsequent treatments.

• #87 Assessment and Management of Immune Thrombocytopenia | OAEM

  https://www.dovepress.com/assessment-and-management-of-immune-thrombocytopenia-itp-in-the-emerge-peer-reviewed-fulltext-article-OAEM

  Immune thrombocytopenia (ITP) is characterized by a platelet count less than 100 10^9/L without anemia or leukopenia. […] Many patients with ITP require no emergent treatment. However, if a patient with suspected ITP presents to the ED with critical hemorrhage, the emergency physician should initiate treatment with a platelet transfusion, corticosteroids, and intravenous immune globulin (IVIG) as soon as possible. […] In cases of critical hemorrhage, standard management includes platelet transfusion, corticosteroids, and intravenous immune globulin (IVIG). […] For these patients, platelet transfusions, corticosteroids, and IVIG are indicated. […] For patients who need treatment in the ED, corticosteroids are the preferred first-line treatment option. […] We recommend emergency physicians initiate IVIG in addition to corticosteroids for patients with critical or major bleeding.

• #88

  https://haematologica.org/article/view/haematol.2021.279513

  The now 26-year-old woman opted for rituximab. […] If a treatment is ineffective, continue the treatment and add another treatment initiating combination therapy. […] Various experimental agents for ITP are being studied and other drugs, currently used for other conditions, are now undergoing trials in ITP.

• #89 Refractory immune thrombocytopenia responding to combination therapy of eltrombopag and low-dose rituximab: a case series | Hematology, Transfusion and Cell Therapy

  https://www.htct.com.br/en-refractory-immune-thrombocytopenia-responding-combination-articulo-S2531137924002931

  Refractory immune thrombocytopenia responding to combination therapy of eltrombopag and low-dose rituximab: a case series […] The common medical treatments for ITP patients who failed with glucocorticoids are thrombopoietin receptor agonists (eltrombopag), immunomodulators (rituximab), and splenectomy. Eltrombopag is the most recommended after glucocorticoids have failed, with response achieved in 40-60 % of patients with continuous therapy. […] Here, we report our experiences of using combination therapy with eltrombopag and low-dose rituximab on four refractory ITP patients, who failed first-line treatment of methylprednisolone and second-line treatment of eltrombopag. […] The combination therapy of eltrombopag with rituximab involves both promoting platelet production and strongly inhibiting platelet destruction.

• #90 Treatment of Early Immune Thrombocytopenia (ITP)

  https://www.onclive.com/view/treatment-of-early-immune-thrombocytopenia-itp

  Drs Bussel and Kessler discuss treatment of early immune thrombocytopenia (ITP). […] We thought we’d start by discussing different frontline therapy strategies beyond IVIG and steroids, which can make it easier for practitioners to cut short the overuse of steroids. […] The TPO agents have been a game changer in the treatment of ITP. […] This has been a very important move. […] One very interesting trial was published in the American Journal of Hematology last year, a randomized prospective study using TPO receptor agonists plus high-dose dexamethasone. […] The study indicated over 80% complete response rate in the TPO-plus-dexamethasone arm vs the high-dose dexamethasone arm alone. […] This information makes this combination possible, and it gives us feasibility to show that there’s safety and efficacy using that combo.

• #91 Refractory immune thrombocytopenia responding to combination therapy of eltrombopag and low-dose rituximab: a case series | Hematology, Transfusion and Cell Therapy

  https://www.htct.com.br/en-refractory-immune-thrombocytopenia-responding-combination-articulo-S2531137924002931

  Refractory immune thrombocytopenia responding to combination therapy of eltrombopag and low-dose rituximab: a case series […] The common medical treatments for ITP patients who failed with glucocorticoids are thrombopoietin receptor agonists (eltrombopag), immunomodulators (rituximab), and splenectomy. Eltrombopag is the most recommended after glucocorticoids have failed, with response achieved in 40-60 % of patients with continuous therapy. […] Here, we report our experiences of using combination therapy with eltrombopag and low-dose rituximab on four refractory ITP patients, who failed first-line treatment of methylprednisolone and second-line treatment of eltrombopag. […] The combination therapy of eltrombopag with rituximab involves both promoting platelet production and strongly inhibiting platelet destruction.

• #92 Refractory immune thrombocytopenia responding to combination therapy of eltrombopag and low-dose rituximab: a case series | Hematology, Transfusion and Cell Therapy

  https://www.htct.com.br/en-refractory-immune-thrombocytopenia-responding-combination-articulo-S2531137924002931

  The present study was conducted to overcome this problem in refractory ITP patients. To the best of our knowledge, we are the first group to report the use of combination therapy using eltrombopag and low-dose rituximab in refractory ITP patients who failed methylprednisolone and eltrombopag treatment. […] In conclusion, we would like to share our experience in treating refractory ITP patients, who failed methylprednisolone and eltrombopag therapy when treatment usually comes to a standstill. The combination therapy of eltrombopag and low-dose rituximab has a high response rate and rapid increase in the platelet count in refractory ITP patients.

• #93 Recent advances in treatments of adult immune thrombocytopenia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9057657/

  Bruton tyrosine kinase (BTK) pathway is also critical for the intracellular transduction signal of FcR-signaling pathway in phagocytosis. […] Long-lived plasma cells that play an important role in anti-platelet antibody production, cannot be completely removed by anti B-cell therapies (e.g., rituximab) alone. […] The neonatal Fc receptor (FcRn) is one of the Fc receptors that binds to IgG and is responsible for transporting of IgG between mother and fetus through the placenta. […] Platelet desialylation has been identified as a novel mechanism of Fc-independent platelet clearance in ITP. […] The involvement of complement pathway in ITP pathogenesis has been investigate for many years.

• #94 New Strategies for the Treatment of Immune Thrombocytopenia – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/march-2022/new-strategies-for-the-treatment-of-immune-thrombocytopenia/

  Although fostamatinib is one of the agents that is recommended as a second-line treatment, I think that it has been inadequately explored as a first-line treatment. […] Fostamatinib is unique in ITP treatment because it is the only treatment based on a SYK inhibitor approach. […] ITP guidelines recommend the use of rituximab in chronic phase ITP; however, many hematologists are also using monoclonal anti-CD 20 antibody in the persistent or newly diagnosed phase of ITP despite the lack of availability of randomized controlled study data. […] At the most recent ASH annual meeting, Dr David Kuter gave an interesting presentation on the use of the experimental Bruton tyrosine kinase inhibitor rilzabrutinib in ITP. […] In a phase 2 study that was published in Blood Advances in 2020, Dr Tadeusz Robak and colleagues investigated the use of the neonatal Fc receptor inhibitor rozanolixizumab in patients with persistent or chronic ITP.

• #95 Recent advances in treatments of adult immune thrombocytopenia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9057657/

  Bruton tyrosine kinase (BTK) pathway is also critical for the intracellular transduction signal of FcR-signaling pathway in phagocytosis. […] Long-lived plasma cells that play an important role in anti-platelet antibody production, cannot be completely removed by anti B-cell therapies (e.g., rituximab) alone. […] The neonatal Fc receptor (FcRn) is one of the Fc receptors that binds to IgG and is responsible for transporting of IgG between mother and fetus through the placenta. […] Platelet desialylation has been identified as a novel mechanism of Fc-independent platelet clearance in ITP. […] The involvement of complement pathway in ITP pathogenesis has been investigate for many years.

• #96 New Strategies for the Treatment of Immune Thrombocytopenia – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/march-2022/new-strategies-for-the-treatment-of-immune-thrombocytopenia/

  Although fostamatinib is one of the agents that is recommended as a second-line treatment, I think that it has been inadequately explored as a first-line treatment. […] Fostamatinib is unique in ITP treatment because it is the only treatment based on a SYK inhibitor approach. […] ITP guidelines recommend the use of rituximab in chronic phase ITP; however, many hematologists are also using monoclonal anti-CD 20 antibody in the persistent or newly diagnosed phase of ITP despite the lack of availability of randomized controlled study data. […] At the most recent ASH annual meeting, Dr David Kuter gave an interesting presentation on the use of the experimental Bruton tyrosine kinase inhibitor rilzabrutinib in ITP. […] In a phase 2 study that was published in Blood Advances in 2020, Dr Tadeusz Robak and colleagues investigated the use of the neonatal Fc receptor inhibitor rozanolixizumab in patients with persistent or chronic ITP.

• #97 Recent advances in treatments of adult immune thrombocytopenia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9057657/

  Bruton tyrosine kinase (BTK) pathway is also critical for the intracellular transduction signal of FcR-signaling pathway in phagocytosis. […] Long-lived plasma cells that play an important role in anti-platelet antibody production, cannot be completely removed by anti B-cell therapies (e.g., rituximab) alone. […] The neonatal Fc receptor (FcRn) is one of the Fc receptors that binds to IgG and is responsible for transporting of IgG between mother and fetus through the placenta. […] Platelet desialylation has been identified as a novel mechanism of Fc-independent platelet clearance in ITP. […] The involvement of complement pathway in ITP pathogenesis has been investigate for many years.

• #98 The treatment of immune thrombocytopenia (ITP)—focus on thrombopoietin receptor agonists – Kuter – Annals of Blood

  https://aob.amegroups.org/article/view/6335/html

  For those failing TPO-RA or not able to receive it, there are a number of other medical options. […] Fostamatinib is a newer agent with a unique mechanism of action. It inhibits syk kinase thereby reducing macrophage destruction of platelets. […] Mycophenolate mofetil is a useful agent in ITP but has not been well studied until recently. […] Dapsone has a long history of use in chronic ITP. It is yet another steroid sparing option in responsive ITP patients. […] Danazol is another steroid sparing medication like dapsone and MMF which is helpful in some ITP patients. […] In refractory patients, we will always reassess the need for therapy. Many patients can live a reasonably normal life at platelet counts under 20,000/L with only occasional need for corticosteroids or antifibrinolytic agents. […] A large number of very promising new ITP treatments (Bruton kinase inhibitors, neonatal Fc receptor inhibitors, anti-CD 38 antibodies) are being developed and patients should be offered access to these trials.

• #99 Recent advances in treatments of adult immune thrombocytopenia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9057657/

  Bruton tyrosine kinase (BTK) pathway is also critical for the intracellular transduction signal of FcR-signaling pathway in phagocytosis. […] Long-lived plasma cells that play an important role in anti-platelet antibody production, cannot be completely removed by anti B-cell therapies (e.g., rituximab) alone. […] The neonatal Fc receptor (FcRn) is one of the Fc receptors that binds to IgG and is responsible for transporting of IgG between mother and fetus through the placenta. […] Platelet desialylation has been identified as a novel mechanism of Fc-independent platelet clearance in ITP. […] The involvement of complement pathway in ITP pathogenesis has been investigate for many years.

• #100 Recent advances in treatments of adult immune thrombocytopenia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9057657/

  Bruton tyrosine kinase (BTK) pathway is also critical for the intracellular transduction signal of FcR-signaling pathway in phagocytosis. […] Long-lived plasma cells that play an important role in anti-platelet antibody production, cannot be completely removed by anti B-cell therapies (e.g., rituximab) alone. […] The neonatal Fc receptor (FcRn) is one of the Fc receptors that binds to IgG and is responsible for transporting of IgG between mother and fetus through the placenta. […] Platelet desialylation has been identified as a novel mechanism of Fc-independent platelet clearance in ITP. […] The involvement of complement pathway in ITP pathogenesis has been investigate for many years.

• #101 Immune Thrombocytopenia (ITP) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/immune-thrombocytopenia-itp

  How is immune thrombocytopenia treated? […] There are a number of treatments for ITP that can help increase platelet levels to decrease or prevent bleeding in children with ITP. While every child responds differently, the majority of cases of ITP in children will resolve within six to twelve months after diagnosis, with or without treatment. […] We customize treatments individually for each patient. The available medications work in different ways to prevent the immune system from attacking platelets. […] When medication is needed to quickly raise the platelet count, the most common choices are steroids and intravenous immunoglobulin (IVIG). These medications are not effective in every child with ITP and may work for only a brief amount of time, after which symptoms can return. […] Fortunately, many additional options have become available, including those listed below. Your hematologist can discuss these with you in detail.

• #102 Immune Thrombocytopenia (ITP) – Seattle Children’s

  https://www.seattlechildrens.org/conditions/itp/

  Children with ITP can lead active, normal lives. Many children do not need treatment. ITP often goes away on its own in a few weeks or months. […] We watch your child closely and recommend the best treatments for them. Treatment does not cure ITP, but it will often increase the number of platelets. Most treatments slow down the loss of platelets. A few treatments help your child make more platelets. […] Many people wonder about blood transfusions as a treatment. We almost never use platelet transfusions to treat ITP because the spleen quickly destroys the new platelets. […] If your child does not have serious bleeding symptoms, we usually recommend watchful waiting. This means we regularly check your child for symptoms of active bleeding and provide treatment if needed. […] Steroids (such as prednisone or dexamethasone) decrease antibody production and may help slow down how fast the spleen removes platelets from the blood.

• #103 Pediatric immune thrombocytopenia (ITP) treatment – Kim – Annals of Blood

  https://aob.amegroups.org/article/view/6316/html

  Pediatric immune thrombocytopenia (ITP) is a heterogeneous autoimmune condition with variability in etiology, bleeding phenotype, need for treatment and response to therapy, as well as duration of disease. […] When treatment is required, first line therapies are relatively standardized and aim to rapidly diminish bleeding risk. […] ITP management continues to evolve: as research expands our understanding of the molecular underpinnings of ITP, providers are increasingly able to refine and individualize treatment regimens. […] For children requiring therapy but without life threatening bleeding, corticosteroids are the recommended first line therapy over IVIG or anti-D. […] Corticosteroids are suggested over IVIG or anti-D by the 2019 American Society of Hematology ITP guidelines, due to low cost, universal availability, ease of outpatient administration, no exposure to multiple blood donors and overall minimal side effects associated with short courses of steroids.

• #104 Immune thrombocytopenic purpura

  https://www.rch.org.au/clinicalguide/guideline_index/immune_thrombocytopenic_purpura/

  Immune thrombocytopenia (ITP) is an isolated low platelet count of 100 x109/L in a well child with an otherwise normal full blood evaluation (FBE) and film. […] The decision to treat a child should be based on clinical symptoms and not the platelet count; the majority do not require treatment. […] The decision to treat a child should be based on the clinical symptoms and not the platelet count. Treatment decisions also need to take into consideration the presence of active bleeding, the risk of future bleeding (eg impending surgery) and psychosocial factors. […] Often require hospital admission. Film must be reviewed by a haematologist prior to starting treatment. […] Urgent consultation with haematology team. […] Consult haematology team for severe or life-threatening bleeding. […] Provide family education.

• #105 Pediatric immune thrombocytopenia (ITP) treatment – Kim – Annals of Blood

  https://aob.amegroups.org/article/view/6316/html

  Pediatric immune thrombocytopenia (ITP) is a heterogeneous autoimmune condition with variability in etiology, bleeding phenotype, need for treatment and response to therapy, as well as duration of disease. […] When treatment is required, first line therapies are relatively standardized and aim to rapidly diminish bleeding risk. […] ITP management continues to evolve: as research expands our understanding of the molecular underpinnings of ITP, providers are increasingly able to refine and individualize treatment regimens. […] For children requiring therapy but without life threatening bleeding, corticosteroids are the recommended first line therapy over IVIG or anti-D. […] Corticosteroids are suggested over IVIG or anti-D by the 2019 American Society of Hematology ITP guidelines, due to low cost, universal availability, ease of outpatient administration, no exposure to multiple blood donors and overall minimal side effects associated with short courses of steroids.

• #106 Immune Thrombocytopenia (ITP) Treatment & Management: Approach Considerations, Thrombopoietin Receptor Agonists, Treatment in Children

  https://emedicine.medscape.com/article/202158-treatment

  In the past decade, thrombopoietin receptor agonists (TPO-RAs) have entered clinical practice as second-line agents, with robust evidence supporting their efficacy. […] Three TPO-RAs are currently available: romiplostin (Nplate), eltrombopag (Promacta), and avatrombopag (Doptelet). […] Romiplostin became available for patients with chronic ITP in 2008. […] Eltrombopag also became available in 2008. […] Avatrombopag, an oral TPO receptor agonist, was approved by the FDA in 2019 for adults with chronic ITP who have had an insufficient response to a previous treatment. […] For pediatric patients requiring treatment, ASH suggests a short course of corticosteroids for first-line treatment rather than IVIG or anti-D immunoglobulin. […] In adults, treatment is recommended for a platelet count 30 109/L.

• #107 Pediatric immune thrombocytopenia (ITP) treatment – Kim – Annals of Blood

  https://aob.amegroups.org/article/view/6316/html

  If a more rapid rise in platelets is desired, IV methylprednisolone may be used. […] Anti-D is another frontline option in children who require treatment. […] Anti-D typically induces a rise in platelet counts within 24-48 hours for approximately 50-77% of children. […] Increasingly, thrombopoietin receptor agonists (TPO-RAs) are being used earlier in the management of pediatric ITP. […] TPO-RAs may have a role as adjunct in the setting of severe or life-threatening bleeding. […] Second line agents are indicated for children who do not respond or relapse after first line agents. […] Increasingly TPO-RAs are being utilized as the initial second line agent for pediatric ITP patients who do not respond to upfront therapies. […] Eltrombopag was approved for use in children with chronic ITP in 2015 following two multicenter, double-blind, placebo controlled trials.

• #108 Pediatric immune thrombocytopenia (ITP) treatment – Kim – Annals of Blood

  https://aob.amegroups.org/article/view/6316/html

  Romiplostim was approved in December 2018 for use in children over 1 year of age who had refractory disease persisting beyond 6 months. […] Though not FDA approved for use in ITP, based on experience with other autoimmune conditions, rituximab has long been used for patients with ITP and inadequate response to upfront therapy. […] In the past, splenectomy was a commonly utilized second line treatment, but is now rarely performed. […] Pediatric response rates to splenectomy are around 60-70% within a day of surgery, hence its application in the case of life-threatening bleeding. […] After first- and second-line therapies have been tried, the next therapy option is selected in discussions between the medical team, caregivers and patient. […] There is a paucity of large, formal studies evaluating outcomes of third line agents in pediatric ITP and certainly, there are no randomized controlled trials comparing the many available therapies directly. […] The genetic and molecular understanding of ITP pathogenesis is expanding. […] A number of newer agents are being employed for adult ITP management which may eventually have utility in pediatric populations.

• #109 Pediatric immune thrombocytopenia (ITP) treatment – Kim – Annals of Blood

  https://aob.amegroups.org/article/view/6316/html

  Romiplostim was approved in December 2018 for use in children over 1 year of age who had refractory disease persisting beyond 6 months. […] Though not FDA approved for use in ITP, based on experience with other autoimmune conditions, rituximab has long been used for patients with ITP and inadequate response to upfront therapy. […] In the past, splenectomy was a commonly utilized second line treatment, but is now rarely performed. […] Pediatric response rates to splenectomy are around 60-70% within a day of surgery, hence its application in the case of life-threatening bleeding. […] After first- and second-line therapies have been tried, the next therapy option is selected in discussions between the medical team, caregivers and patient. […] There is a paucity of large, formal studies evaluating outcomes of third line agents in pediatric ITP and certainly, there are no randomized controlled trials comparing the many available therapies directly. […] The genetic and molecular understanding of ITP pathogenesis is expanding. […] A number of newer agents are being employed for adult ITP management which may eventually have utility in pediatric populations.

• #110 Immune Thrombocytopenic Purpura (ITP)

  https://patient.info/allergies-blood-immune/blood-clotting-tests/immune-thrombocytopenia

  Surgery to remove the spleen (splenectomy) is very rarely done in children with ITP. It is only really considered as an option if your child has life-threatening bleeding or severe chronic disease that is affecting their day-to-day functioning. […] What is the treatment for ITP in adults? […] If treatment is needed then the first treatment that tends to be used in an adult with ITP is usually steroids. […] Surgery to remove the spleen (splenectomy) is used more often in adults than in children. It is more likely to result in a longer-lasting normal number of platelets. […] If the above treatments do not work, there are several other options. […] A medicine called rituximab has also produced good responses. Other new treatments include medicines which help you make more platelets. […] Fostamatinib is usually used at the same stage of treatment as rituximab – for adults with long-term symptoms which have not responded to other treatments.

• #111 Immune Thrombocytopenia (ITP): Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/5726-immune-thrombocytopenia

  If you have ITP, you may need medication for the rest of your life to ensure your body makes enough platelets. And youll need to avoid activities that increase the chance youll get hurt and start bleeding. […] Contact your provider if you notice new bruises or petechia that may be signs that your condition is getting worse. Your provider may do tests to check your platelet levels. […] It may help to know that your fetus wont be affected by ITP. Your baby may have fewer platelets at birth, but their platelet count will increase. If you have a mild case of immune thrombocytopenia during pregnancy, you wont need treatment. If you do need treatment during pregnancy, your provider will recommend treatments that wont affect your fetus. […] Healthcare providers can treat the condition, but they cant cure it.

• #112 Immune Thrombocytopenia (ITP) Treatment & Management: Approach Considerations, Thrombopoietin Receptor Agonists, Treatment in Children

  https://emedicine.medscape.com/article/202158-treatment

  The ASH recommends that if treatment is needed, shorter courses of corticosteroids (6 weeks) are preferred over prolonged courses as first-line treatment. […] In adults with ITP lasting 3 months who are corticosteroid-dependent or have no response to corticosteroids, the ASH guidelines suggest either splenectomy or a TPO-RA. […] Fostamatinib (Tavalisse) was approved by the US Food and Drug Administration (FDA) in 2018 for thrombocytopenia in adults with chronic ITP who have had an insufficient response to a previous treatment. […] Pregnant women with no bleeding manifestations whose platelet counts are 30 109/L or higher do not require any treatment until 36 weeks’ gestation, unless delivery is imminent. […] Refractory ITP in pregnancy can be treated with corticosteroids and IVIG in combination, or splenectomy (in the second trimester). […] In persons with acute immune thrombocytopenia (ITP), splenectomy usually results in rapid, complete, and life-long clinical remission. […] If 6 months of medical management fails to increase the platelet count to a safe range (about 30,000/L), splenectomy becomes an option.

• #113 Immune Thrombocytopenia (ITP): Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/202158-overview

  Corticosteroids remain the drugs of choice for the initial management of acute ITP. […] Oral prednisone, IV methylprednisolone, or high-dose dexamethasone may be used. […] IV immunoglobulin (IVIG) has been the drug of second choice for many years. […] For Rh(D)-positive patients with intact spleens, IV Rho immunoglobulin (RhIG) offers comparable efficacy, less toxicity, greater ease of administration, and a lower cost than IVIG. […] Options in patients with corticosteroid dependence or unresponsiveness include thrombopoietin receptor agonists (TPO-RAs; ie, romiplostim, eltrombopag, avatrombopag), rituximab, or splenectomy. […] TPO-RAs may maintain platelet counts at safe levels in patients with chronic ITP refractory to splenectomy. […] If the platelet count is less than 50 109/L (50 103/L) before delivery, treatment with oral prednisone and IVIG is recommended. […] Rarely, splenectomy may be required to manage acute hemorrhage.

• #114 Immune Thrombocytopenia (ITP) Treatment & Management: Approach Considerations, Thrombopoietin Receptor Agonists, Treatment in Children

  https://emedicine.medscape.com/article/202158-treatment

  The ASH recommends that if treatment is needed, shorter courses of corticosteroids (6 weeks) are preferred over prolonged courses as first-line treatment. […] In adults with ITP lasting 3 months who are corticosteroid-dependent or have no response to corticosteroids, the ASH guidelines suggest either splenectomy or a TPO-RA. […] Fostamatinib (Tavalisse) was approved by the US Food and Drug Administration (FDA) in 2018 for thrombocytopenia in adults with chronic ITP who have had an insufficient response to a previous treatment. […] Pregnant women with no bleeding manifestations whose platelet counts are 30 109/L or higher do not require any treatment until 36 weeks’ gestation, unless delivery is imminent. […] Refractory ITP in pregnancy can be treated with corticosteroids and IVIG in combination, or splenectomy (in the second trimester). […] In persons with acute immune thrombocytopenia (ITP), splenectomy usually results in rapid, complete, and life-long clinical remission. […] If 6 months of medical management fails to increase the platelet count to a safe range (about 30,000/L), splenectomy becomes an option.

• #115

  https://haematologica.org/article/view/haematol.2021.279513

  Another option for second-line therapy would be a thrombopoietin receptor agonist (TPO-RA). […] Fostamatinib is a first-in-class, orally active spleen tyrosine kinase (Syk) inhibitor indicated for the treatment of ITP. […] The American Society of Hematology guidelines and international consensus report recommend that splenectomy be delayed to at least 1 year after the diagnosis of ITP, since the rate of resolution of ITP within the first 1-3 years of disease appears substantial even in adults. […] As this woman could not taper her prednisone successfully, still had bleeding, and had a platelet count 20×109/L, she met the criteria to receive a second-line treatment. […] In summary, according to three reports of the use of three different thrombopoietin agents in pregnancy, these drugs appear to be safe as a class with no information available for avatrombopag, very limited information for eltrombopag, and considerable safety but little efficacy information for romiplostim.

• #116 Immune Thrombocytopenia (ITP): Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/5726-immune-thrombocytopenia

  If you have ITP, you may need medication for the rest of your life to ensure your body makes enough platelets. And youll need to avoid activities that increase the chance youll get hurt and start bleeding. […] Contact your provider if you notice new bruises or petechia that may be signs that your condition is getting worse. Your provider may do tests to check your platelet levels. […] It may help to know that your fetus wont be affected by ITP. Your baby may have fewer platelets at birth, but their platelet count will increase. If you have a mild case of immune thrombocytopenia during pregnancy, you wont need treatment. If you do need treatment during pregnancy, your provider will recommend treatments that wont affect your fetus. […] Healthcare providers can treat the condition, but they cant cure it.

• #117 Immune thrombocytopenia – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/138

  Immune thrombocytopenia (ITP) in children typically presents with a preceding viral illness and an abrupt onset. […] Treatment is based on platelet count and bleeding symptoms. Patients with life-threatening bleeding, regardless of platelet count, can be considered for combination therapy with corticosteroids, intravenous immunoglobulin (IVIG), and platelet transfusion. […] Initial treatment options for newly diagnosed ITP include observation, or a corticosteroid and/or IVIG depending on platelet count and bleeding symptoms. […] Subsequent treatment with thrombopoietin receptor agonists, rituximab, or fostamatinib (adults only) can be considered in patients who are unresponsive to, or intolerant of, initial treatment. […] Salvage therapy with oral immunosuppressants, such as mycophenolate, azathioprine, or dapsone, can be considered in patients who do not respond to multiple subsequent treatments.

• #118 Assessment and Management of Immune Thrombocytopenia | OAEM

  https://www.dovepress.com/assessment-and-management-of-immune-thrombocytopenia-itp-in-the-emerge-peer-reviewed-fulltext-article-OAEM

  Immune thrombocytopenia (ITP) is characterized by a platelet count less than 100 10^9/L without anemia or leukopenia. […] Many patients with ITP require no emergent treatment. However, if a patient with suspected ITP presents to the ED with critical hemorrhage, the emergency physician should initiate treatment with a platelet transfusion, corticosteroids, and intravenous immune globulin (IVIG) as soon as possible. […] In cases of critical hemorrhage, standard management includes platelet transfusion, corticosteroids, and intravenous immune globulin (IVIG). […] For these patients, platelet transfusions, corticosteroids, and IVIG are indicated. […] For patients who need treatment in the ED, corticosteroids are the preferred first-line treatment option. […] We recommend emergency physicians initiate IVIG in addition to corticosteroids for patients with critical or major bleeding.

• #119 Assessment and Management of Immune Thrombocytopenia | OAEM

  https://www.dovepress.com/assessment-and-management-of-immune-thrombocytopenia-itp-in-the-emerge-peer-reviewed-fulltext-article-OAEM

  Platelet transfusions should only be routinely initiated if critical bleeding is present, or if an emergent major surgery is needed. […] In general, the treatment of ITP is based on low quality evidence and expert opinion as large randomized trials are lacking. […] The goal of treatment is to prevent or treat significant bleeding, not to normalize the platelet count. […] For patients with severe or refractory cases of ITP, splenectomy, rituximab, mycophenolate mofetil, and other immunosuppressive agents may be considered.

• #120 Immune Thrombocytopenia (ITP) – Hematology and Oncology – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/hematology-and-oncology/thrombocytopenia-and-platelet-dysfunction/immune-thrombocytopenia-itp

  Splenectomy can achieve a complete remission in about two thirds of patients who relapse after initial corticosteroid therapy. […] If thrombocytopenia can be controlled with second-line medical therapies, splenectomy is often not necessary. […] Second-line medical therapies include thrombopoietin receptor agonists (TPO-RAs), rituximab, fostamatinib, or other immunosuppressive drugs. […] In children or adults with immune thrombocytopenia and life-threatening bleeding, rapid phagocytic blockade is attempted by giving IVIG 1 g/kg once a day for 1 to 2 days or, in Rh-positive patients, a single dose of IV anti-D immune globulin 75 mcg/kg. […] High-dose methylprednisolone (1 g IV once a day for 3 days) is easier to administer than IVIG or IV anti-D immune globulin but may not be as effective.

• #121 Assessment and Management of Immune Thrombocytopenia | OAEM

  https://www.dovepress.com/assessment-and-management-of-immune-thrombocytopenia-itp-in-the-emerge-peer-reviewed-fulltext-article-OAEM

  Immune thrombocytopenia (ITP) is characterized by a platelet count less than 100 10^9/L without anemia or leukopenia. […] Many patients with ITP require no emergent treatment. However, if a patient with suspected ITP presents to the ED with critical hemorrhage, the emergency physician should initiate treatment with a platelet transfusion, corticosteroids, and intravenous immune globulin (IVIG) as soon as possible. […] In cases of critical hemorrhage, standard management includes platelet transfusion, corticosteroids, and intravenous immune globulin (IVIG). […] For these patients, platelet transfusions, corticosteroids, and IVIG are indicated. […] For patients who need treatment in the ED, corticosteroids are the preferred first-line treatment option. […] We recommend emergency physicians initiate IVIG in addition to corticosteroids for patients with critical or major bleeding.

• #122 Updated Recommendations for the Treatment of Immune Thrombocytopenia – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/august-2020/updated-recommendations-for-the-treatment-of-immune-thrombocytopenia/

  The recent ASH guidelines also moved thrombopoietin receptor agonists into a more up-front setting according to the response rates at 1 month and the durability of the responses. […] Rituximab is a chimeric monoclonal anti-CD20 antibody that eliminates B cells by triggering apoptosis, antibody-dependent cell-mediated cytotoxicity, and complement-mediated lysis. […] Splenectomy is highly effective as second-line treatment. The response rate is as high as 88%, and up to 68% of individuals experience remission according to a 2004 article by Kojouri and colleagues in Blood. […] High-dose dexamethasone is an excellent choice for the treatment of ITP and may be preferable to prednisone in many instances, especially when severe thrombocytopenia is present. […] Patients with thrombocytopenia who are admitted to the hospital with acute catastrophic bleeding are treated emergently with therapies to (1) control the rate of platelet destruction and (2) supplement the platelet count.

• #123 Assessment and Management of Immune Thrombocytopenia | OAEM

  https://www.dovepress.com/assessment-and-management-of-immune-thrombocytopenia-itp-in-the-emerge-peer-reviewed-fulltext-article-OAEM

  Platelet transfusions should only be routinely initiated if critical bleeding is present, or if an emergent major surgery is needed. […] In general, the treatment of ITP is based on low quality evidence and expert opinion as large randomized trials are lacking. […] The goal of treatment is to prevent or treat significant bleeding, not to normalize the platelet count. […] For patients with severe or refractory cases of ITP, splenectomy, rituximab, mycophenolate mofetil, and other immunosuppressive agents may be considered.

• #124 Immune thrombocytopenic purpura (ITP): MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000535.htm

  People with ITP should not take aspirin, ibuprofen, or warfarin, because these medicines interfere with platelet function or blood clotting, and bleeding may occur. […] With treatment, the chance of remission (a symptom-free period) is good. In rare cases, ITP may become a long-term condition in adults and reappear, even after a symptom-free period.

• #125 Self-Care for ITP

  https://www.everydayhealth.com/immune-thrombocytopenia/itp-self-care-tips/

  For most people who have ITP, treatment includes the use of drugs that suppress your immune systems attack on your platelets, according to the Mayo Clinic at least initially, until your platelet levels are high enough. […] While some people with ITP are at high risk for bleeding and will need to follow stricter precautions for injuries, such as topical or oral medications, most people who have ITP can treat minor cuts in the usual manner, says Tellez. […] Medications like aspirin or ibuprofen, and some supplements like fish oil, alter the way platelets work, says Tellez. And so theyre going to potentially put someone at increased risk for bleeding. […] Connecting with other people online or in a local support group can help you learn what to expect with ITP, but its important to make sure that any online forums you visit are moderated and supply accurate information. […] To get a good grasp of how to manage ITP, you should read up on the disorder. It doesnt have to be pages of heavy-duty literature, says Tellez. Its just some basic concepts, some bullet points about things to do. Just those few things can be very helpful.

• #126 Self-Care for ITP

  https://www.everydayhealth.com/immune-thrombocytopenia/itp-self-care-tips/

  For most people who have ITP, treatment includes the use of drugs that suppress your immune systems attack on your platelets, according to the Mayo Clinic at least initially, until your platelet levels are high enough. […] While some people with ITP are at high risk for bleeding and will need to follow stricter precautions for injuries, such as topical or oral medications, most people who have ITP can treat minor cuts in the usual manner, says Tellez. […] Medications like aspirin or ibuprofen, and some supplements like fish oil, alter the way platelets work, says Tellez. And so theyre going to potentially put someone at increased risk for bleeding. […] Connecting with other people online or in a local support group can help you learn what to expect with ITP, but its important to make sure that any online forums you visit are moderated and supply accurate information. […] To get a good grasp of how to manage ITP, you should read up on the disorder. It doesnt have to be pages of heavy-duty literature, says Tellez. Its just some basic concepts, some bullet points about things to do. Just those few things can be very helpful.

• #127 Immune Thrombocytopenia (ITP): Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/5726-immune-thrombocytopenia

  If you have ITP, you may need medication for the rest of your life to ensure your body makes enough platelets. And youll need to avoid activities that increase the chance youll get hurt and start bleeding. […] Contact your provider if you notice new bruises or petechia that may be signs that your condition is getting worse. Your provider may do tests to check your platelet levels. […] It may help to know that your fetus wont be affected by ITP. Your baby may have fewer platelets at birth, but their platelet count will increase. If you have a mild case of immune thrombocytopenia during pregnancy, you wont need treatment. If you do need treatment during pregnancy, your provider will recommend treatments that wont affect your fetus. […] Healthcare providers can treat the condition, but they cant cure it.

• #128 Idiopathic thrombocytopenic purpura (ITP)

  https://www.rch.org.au/kidsinfo/fact_sheets/Idiopathic_thrombocytopenic_purpura_ITP/

  Idiopathic thrombocytopenic purpura (ITP) is a bleeding disorder resulting from a shortage of platelets in the blood. […] In a very small number of children, the platelet count does not return to normal, even after six to 12 months. In these cases, doctors will determine the appropriate treatment for your child. […] There are several treatment options for ITP. […] The doctor will discuss the best treatment option for your child. Your child may need blood tests every few days to monitor the progress of the condition. […] While your child’s platelet count is very low, they may be advised to avoid activities that might cause bruising or bleeding (e.g. avoid climbing equipment at school or not ride their bicycle). […] Children with ITP should not take aspirin or ibuprofen. Paracetamol is quite safe to use if your child needs pain relief.

• #129 Immune Thrombocytopenia (ITP): Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/5726-immune-thrombocytopenia

  If you have ITP, you may need medication for the rest of your life to ensure your body makes enough platelets. And youll need to avoid activities that increase the chance youll get hurt and start bleeding. […] Contact your provider if you notice new bruises or petechia that may be signs that your condition is getting worse. Your provider may do tests to check your platelet levels. […] It may help to know that your fetus wont be affected by ITP. Your baby may have fewer platelets at birth, but their platelet count will increase. If you have a mild case of immune thrombocytopenia during pregnancy, you wont need treatment. If you do need treatment during pregnancy, your provider will recommend treatments that wont affect your fetus. […] Healthcare providers can treat the condition, but they cant cure it.

• #130 Immune Thrombocytopenia (ITP) – Seattle Children’s

  https://www.seattlechildrens.org/conditions/itp/

  Immunoglobulin may help block the antibodies that destroy platelets. […] If your child’s ITP is very serious or long-lasting, your child’s doctor will talk with you about other medicines. […] If your child’s ITP is severe and medicine is not working, the doctor may recommend removing your child’s spleen. This is called splenectomy. […] We usually check your child’s platelet count at each clinic visit. A normal platelet count is above 100,000.

• #131 Self-Care for ITP

  https://www.everydayhealth.com/immune-thrombocytopenia/itp-self-care-tips/

  For most people who have ITP, treatment includes the use of drugs that suppress your immune systems attack on your platelets, according to the Mayo Clinic at least initially, until your platelet levels are high enough. […] While some people with ITP are at high risk for bleeding and will need to follow stricter precautions for injuries, such as topical or oral medications, most people who have ITP can treat minor cuts in the usual manner, says Tellez. […] Medications like aspirin or ibuprofen, and some supplements like fish oil, alter the way platelets work, says Tellez. And so theyre going to potentially put someone at increased risk for bleeding. […] Connecting with other people online or in a local support group can help you learn what to expect with ITP, but its important to make sure that any online forums you visit are moderated and supply accurate information. […] To get a good grasp of how to manage ITP, you should read up on the disorder. It doesnt have to be pages of heavy-duty literature, says Tellez. Its just some basic concepts, some bullet points about things to do. Just those few things can be very helpful.

• #132 Self-Care for ITP

  https://www.everydayhealth.com/immune-thrombocytopenia/itp-self-care-tips/

  For most people who have ITP, treatment includes the use of drugs that suppress your immune systems attack on your platelets, according to the Mayo Clinic at least initially, until your platelet levels are high enough. […] While some people with ITP are at high risk for bleeding and will need to follow stricter precautions for injuries, such as topical or oral medications, most people who have ITP can treat minor cuts in the usual manner, says Tellez. […] Medications like aspirin or ibuprofen, and some supplements like fish oil, alter the way platelets work, says Tellez. And so theyre going to potentially put someone at increased risk for bleeding. […] Connecting with other people online or in a local support group can help you learn what to expect with ITP, but its important to make sure that any online forums you visit are moderated and supply accurate information. […] To get a good grasp of how to manage ITP, you should read up on the disorder. It doesnt have to be pages of heavy-duty literature, says Tellez. Its just some basic concepts, some bullet points about things to do. Just those few things can be very helpful.

• #133 Immune Thrombocytopenia Resources | Foundation for Women & Girls with Blood Disorders

  https://www.fwgbd.org/resources/immune-thrombocytopenia-resources

  Immune thrombocytopenia (ITP) is a debilitating autoimmune disorder characterized by increased platelet destruction and reduction in blood platelets, resulting in an increased incidence of bleeding. […] ASH recently revised its 2011 evidence-based guidelines for treatment and management of ITP. The 2019 guidelines focus on determining the optimal treatment protocol and second-line agents where necessary, in an effort to avoid treatments that have little evidence of success and may have detrimental side effects that outweigh possible benefits. […] For many patients, current treatments, particularly corticosteroids, are associated with multiple, even severe, side effects that may lead to patients stopping or reducing therapy, despite the overall benefits. Successful treatment of ITP involves open communication and support between providers and patients in order to help patients navigate the burden of managing their disease and enhance their quality of life. […] ASH Guidelines for Treatment of COVID-19 and ITP ASH has revised its first-line treatment guidelines for ITP patients as a temporary measure in light of COVID-19.

• #134

  https://link.springer.com/article/10.1007/s44337-024-00008-8

  Immune thrombocytopenia (ITP) is a hematologic disorder characterized by a low platelet count, leading to an increased risk of bleeding. […] Treatment modalities have evolved significantly from the traditional approach of splenectomy to the use of corticosteroids, immunosuppressants, and novel targeted therapies. […] The efficacy and safety profiles of these treatments have been refined through clinical trials and consensus guidelines. […] Emerging therapies, including immunomodulatory agents, hold promise for improving outcomes and quality of life for patients with ITP. […] In 1977, Harrington proposed that only patients with a platelet count below 30,000 per cubic millimeter need treatment, and a platelet count of 50,000 per cubic millimeter is sufficient to assure safety. […] It has been generally accepted since 1977 that glucocorticoid should be the first-line treatment for ITP.

• #135

  https://journals.lww.com/md-journal/fulltext/2024/01190/recent_advances_in_the_management_of_immune.42.aspx

  Autoimmune disorders place a substantial burden on the healthcare system all over the world affecting almost 3% to 8% of the population. Immune thrombocytopenic purpura (ITP), also known as idiopathic thrombocytopenic purpura, is a blood disorder in which the body immune system destroys platelets, leading to low platelet counts in the blood (peripheral blood platelet count150109/L). […] Corticosteroids, intravenous immunoglobulin (IVIG), immunosuppressants, rituximab, and thrombopoietin receptor agonists (TPO-RAs) are some of the advanced treatments for ITP. […] Recently, significant advancements have been made in the understanding and treatment of ITP. […] According to research, it is crucial to develop individualized treatment plans for ITP patients based on their age, platelet count, risk of bleeding, and comorbidities.

• #136 Immune Thrombocytopenia (ITP) Treatment & Management: Approach Considerations, Thrombopoietin Receptor Agonists, Treatment in Children

  https://emedicine.medscape.com/article/202158-treatment

  The ASH recommends that if treatment is needed, shorter courses of corticosteroids (6 weeks) are preferred over prolonged courses as first-line treatment. […] In adults with ITP lasting 3 months who are corticosteroid-dependent or have no response to corticosteroids, the ASH guidelines suggest either splenectomy or a TPO-RA. […] Fostamatinib (Tavalisse) was approved by the US Food and Drug Administration (FDA) in 2018 for thrombocytopenia in adults with chronic ITP who have had an insufficient response to a previous treatment. […] Pregnant women with no bleeding manifestations whose platelet counts are 30 109/L or higher do not require any treatment until 36 weeks’ gestation, unless delivery is imminent. […] Refractory ITP in pregnancy can be treated with corticosteroids and IVIG in combination, or splenectomy (in the second trimester). […] In persons with acute immune thrombocytopenia (ITP), splenectomy usually results in rapid, complete, and life-long clinical remission. […] If 6 months of medical management fails to increase the platelet count to a safe range (about 30,000/L), splenectomy becomes an option.

• #137

  https://www.ashclinicalnews.org/education/how-i-treat-in-brief/corticosteroid-dependent-corticosteroid-unresponsive-primary-itp/

  Approximately 80% of adult patients with ITP have treatment failure with corticosteroids (the standard frontline therapy) or become dependent on them and require second-line therapy. […] Corticosteroids are the standard first-line treatment and, although 75% of adults with ITP respond to corticosteroids, approximately 80% of adult patients with ITP will experience treatment failure with corticosteroids or become dependent on them and require second-line therapy. […] Current clinical guidelines recommend limiting the maximum duration of corticosteroid treatment to six to eight weeks. […] Corticosteroids, at one time given for many months, are now strongly recommended to be discontinued by six to eight weeks. […] Splenectomy, the standard second-line therapy for decades, is now recommended to be delayed for at least one to two years, allowing for more patients to achieve remission with medical therapies before considering a surgical option. […] As newer medications are continuously being developed and evaluated in randomized clinical trials, it is highly recommended that therapies with evidence from randomized controlled trials be tried first, leaving therapies with less validation for later use.

• #138 The treatment of immune thrombocytopenia (ITP)—focus on thrombopoietin receptor agonists – Kuter – Annals of Blood

  https://aob.amegroups.org/article/view/6335/html

  Immune thrombocytopenia (ITP) is an autoimmune disease characterized by increased platelet destruction along with reduced platelet production. All treatments attempt either to reduce the rate of platelet production or increase the rate of platelet production. […] New treatment guidelines have supported a shift from corticosteroids and splenectomy to newer medical treatments that mitigate the thrombocytopenia and avoid splenectomy. The thrombopoietin receptor agonists (TPO-RA), romiplostim, eltrombopag, and avatrombopag, have markedly altered the treatment of ITP. Response rates of 80-90% are routinely obtained and responses are usually maintained with continued therapy. […] Current guidelines encourage their use as early as 3 months into the disease course, sometimes even earlier. TPO-RA do not need to be continued forever; about a third of patients in the first year and about another third after two years have a remission.

• #139 Updated Recommendations for the Treatment of Immune Thrombocytopenia – Hematology & Oncology

  https://www.hematologyandoncology.net/archives/august-2020/updated-recommendations-for-the-treatment-of-immune-thrombocytopenia/

  The recent ASH guidelines also moved thrombopoietin receptor agonists into a more up-front setting according to the response rates at 1 month and the durability of the responses. […] Rituximab is a chimeric monoclonal anti-CD20 antibody that eliminates B cells by triggering apoptosis, antibody-dependent cell-mediated cytotoxicity, and complement-mediated lysis. […] Splenectomy is highly effective as second-line treatment. The response rate is as high as 88%, and up to 68% of individuals experience remission according to a 2004 article by Kojouri and colleagues in Blood. […] High-dose dexamethasone is an excellent choice for the treatment of ITP and may be preferable to prednisone in many instances, especially when severe thrombocytopenia is present. […] Patients with thrombocytopenia who are admitted to the hospital with acute catastrophic bleeding are treated emergently with therapies to (1) control the rate of platelet destruction and (2) supplement the platelet count.

• #140 The treatment of immune thrombocytopenia (ITP)—focus on thrombopoietin receptor agonists – Kuter – Annals of Blood

  https://aob.amegroups.org/article/view/6335/html

  For those failing TPO-RA or not able to receive it, there are a number of other medical options. […] Fostamatinib is a newer agent with a unique mechanism of action. It inhibits syk kinase thereby reducing macrophage destruction of platelets. […] Mycophenolate mofetil is a useful agent in ITP but has not been well studied until recently. […] Dapsone has a long history of use in chronic ITP. It is yet another steroid sparing option in responsive ITP patients. […] Danazol is another steroid sparing medication like dapsone and MMF which is helpful in some ITP patients. […] In refractory patients, we will always reassess the need for therapy. Many patients can live a reasonably normal life at platelet counts under 20,000/L with only occasional need for corticosteroids or antifibrinolytic agents. […] A large number of very promising new ITP treatments (Bruton kinase inhibitors, neonatal Fc receptor inhibitors, anti-CD 38 antibodies) are being developed and patients should be offered access to these trials.

• #141

  https://journals.lww.com/md-journal/fulltext/2024/01190/recent_advances_in_the_management_of_immune.42.aspx

  The article also looks at how future developments in gene editing, bispecific antibody therapies, and cellular therapy may completely change the treatment of ITP. […] In the past 10 years, there has been a shift toward using treatments with reduced or no immune suppression, such as thrombopoietin receptor agonists (TPO-RAs). […] TPO-RAs are a promising new class of drugs that have been shown to be effective in increasing platelet counts and reducing bleeding in ITP patients. […] The shift away from immune suppression and toward TPO-RAs is a positive development in patients with ITP. […] Individualized treatment approaches are crucial for ITP patients because ITP can manifest differently. […] Treatment choices can be significantly influenced by patient characteristics, such as IVIG, and corticosteroids are frequently used in the treatment of ITP in children.

• #142

  https://journals.lww.com/md-journal/fulltext/2024/01190/recent_advances_in_the_management_of_immune.42.aspx

  However, the negative effects of these medications may be more common in older ITP patients. […] Therefore, medical professionals might need to alter the medication dosage or decide to adopt a different approach. […] Researchers are investigating how specific immune cell types, such as T cells, B cells, and macrophages, contribute to the onset and progression of ITP. […] The creation of fresh and focused treatments may have resulted from this study. […] Although the precise genes involved remain unknown, genetics is thought to play a role in ITP. […] The gut microbiome is a group of microbes that inhabits the gut. The function of gut microbiota in the onset and progression of ITP has been studied by researchers. […] New noninvasive therapeutic approaches may have resulted from this research. […] In conclusion, tremendous progress has been made in understanding and managing ITP. The disease must still be fully understood, and new and efficient treatments are needed.

• #143

  https://journals.lww.com/md-journal/fulltext/2024/01190/recent_advances_in_the_management_of_immune.42.aspx

  Autoimmune disorders place a substantial burden on the healthcare system all over the world affecting almost 3% to 8% of the population. Immune thrombocytopenic purpura (ITP), also known as idiopathic thrombocytopenic purpura, is a blood disorder in which the body immune system destroys platelets, leading to low platelet counts in the blood (peripheral blood platelet count150109/L). […] Corticosteroids, intravenous immunoglobulin (IVIG), immunosuppressants, rituximab, and thrombopoietin receptor agonists (TPO-RAs) are some of the advanced treatments for ITP. […] Recently, significant advancements have been made in the understanding and treatment of ITP. […] According to research, it is crucial to develop individualized treatment plans for ITP patients based on their age, platelet count, risk of bleeding, and comorbidities.

• #144

  https://journals.lww.com/md-journal/fulltext/2024/01190/recent_advances_in_the_management_of_immune.42.aspx

  The article also looks at how future developments in gene editing, bispecific antibody therapies, and cellular therapy may completely change the treatment of ITP. […] In the past 10 years, there has been a shift toward using treatments with reduced or no immune suppression, such as thrombopoietin receptor agonists (TPO-RAs). […] TPO-RAs are a promising new class of drugs that have been shown to be effective in increasing platelet counts and reducing bleeding in ITP patients. […] The shift away from immune suppression and toward TPO-RAs is a positive development in patients with ITP. […] Individualized treatment approaches are crucial for ITP patients because ITP can manifest differently. […] Treatment choices can be significantly influenced by patient characteristics, such as IVIG, and corticosteroids are frequently used in the treatment of ITP in children.

• #145 Chronic Immune Thrombocytopenia (ITP)

  https://www.webmd.com/a-to-z-guides/chronic-immune-thrombocytopenia

  If medicine doesn’t improve your platelet count, you might need surgery to remove your spleen, called a splenectomy. The spleen is part of your immune system. In ITP, it plays a big role in destroying platelets. Removing the spleen leads to long-term remission in about 60% of people who have this surgery. […] There is no cure for ITP. But corticosteroids and other medicines increase platelet counts and improve symptoms in most people. […] Chronic ITP can last for many years, and you may have to stay on treatment for the long term to prevent complications like severe bleeding. Corticosteroids are the main treatment for ITP. If they don’t work, medicines that increase platelet production or stop your immune system from attacking platelets may help.

• #146 Immune thrombocytopenia (ITP) | disease | symptoms | Sobi

  https://www.sobi.com/en/sobi-itp-immune-thrombocytopenia

  Only nine or ten people in every 100,000 have ITP, a rare autoimmune disease affecting platelet production and characterised by fatigue, bruising and bleeding. […] But now, thanks to increased awareness of treatment options, a better life may be possible for people living with ITP. […] There is no cure for ITP but there are treatments that can raise the platelet count and thereby counteract the symptoms and help people to live with the disease. […] Treatments include steroids as an initial short-term measure, immunoglobulin, drugs to reduce the immune system response that is causing the platelets to be destroyed, and TPO-RAs (thrombopoietin-receptor agonists), which can lift the platelet count by boosting platelet production in the bone marrow. […] For patients who continue to have severe symptoms despite treatments, their doctor may suggest a splenectomy (surgery to remove the spleen).

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