Which medications are used to treat immune thrombocytopenic purpura (ITP) in adults?

Updated: Apr 22, 2018
  • Author: Craig M Kessler, MD, MACP; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

In adults, treatment is recommended for a platelet count < 30×109/L. The ASH recommends that if treatment is needed and corticosteroids are given, longer courses (eg, prednisone 1 mg/kg orally for 21 days then tapered) are preferred over shorter courses of corticosteroids or IVIG as first-line treatment. IVIG be used with corticosteroids in patients who require a more rapid increase in platelet count. If corticosteroids are contraindicated, either IVIG (initially, 1 g/kg in a single dose) or IV RhIG (in appropriate patients) may be used as a first-line treatment. [8]

The ASH suggests consideration of thrombopoietin receptor agonists for patients at risk of bleeding when splenectomy is contraindicated and at least one other therapy has failed, and recommends thrombopoietin receptor agonists In adult patients  who relapse after splenectomy and are at risk for bleeding. The ASH suggests consideration of rituximab in patients at risk of bleeding when one line of therapy (eg, corticosteroids, IVIg, splenectomy) has failed. [8]

Gudbrandsdottir et al reported that, compared with dexamethasone monotherapy, treatment with the combination of dexamethasone and rituximab resulted in higher response rates (58%, versus 37% with dexamethasone alone; P = 0.02), longer time to relapse ( P = 0.03) and longer time to rescue treatment (P = 0.007) However, the incidence of grade 3 to 4 adverse events was higher in the rituximab plus dexamethasone group (P = 0.04). The study included 113 adult patients with newly diagnosed, symptomatic primary ITP. [50]


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