Management of adults with primary immune thrombocytopenia (ITP) has changed dramatically in the past 10 years.
New regimens of corticosteroids for first-line treatment have been introduced and are currently being evaluated in a randomized clinical trial.
Many patients may not have durable remissions with initial corticosteroid regimens and may require additional, second-line, treatment.
For these patients, rituximab has been increasingly used, as it has for other autoimmune disorders, and new thrombopoietin (TPO)-receptor agonists have been developed.
Although splenectomy was the first effective and remains the most effective treatment for ITP, inducing durable complete remissions in 66% of patients, rituximab and TPO-receptor agonists are now additional options for second-line treatment.
For patients who continue to have severe and symptomatic thrombocytopenia following failure of multiple treatments, including splenectomy and rituximab, the TPO-receptor agonists are effective as third-line treatment for maintaining safe platelets counts to prevent bleeding symptoms in most patients.
2012-04-20
Eng.
Department of Biostatistics and Epidemiology, College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73190, USA. james-george [at] ouhsc.edu
Am J Hematol. 2012 May;87 Suppl 1():S12-5
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