What are the International Consensus Report recommendations for the initial treatment of immune thrombocytopenia (ITP) in adults?

Updated: Jan 11, 2020
  • Author: Craig M Kessler, MD, MACP; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

Recommendations for initial treatment of newly diagnosed patients are as follows:

  • Corticosteroids are the standard initial treatment for adults with ITP who need treatment and do not have a relative contradiction: prednisone or prednisolone at 1 mg/kg (maximum dose 80 mg, even in patients weighing >80 kg) for 2 weeks, to a maximum of 3 weeks; or dexamethasone 40 mg/d for 4 days, repeated up to 3 times
  • If a response is seen (eg, platelets > 50 × 10 9/L), taper the prednisone/prednisolone, aiming for discontinuation by 6 weeks (maximum 8 weeks), even if the platelet count drops during the taper.
  • If there is no response to the initial dose within 2 weeks, taper the prednisone/prednisolone rapidly over 1 week and discontinue.
  • Longer courses of steroids should be avoided, although occasional patients may benefit from continuous low-dose corticosteroids (eg, ≤5 mg/d).
  • Use of IVIG (1 g/kg on 1 or 2 consecutive days or 0.4 g/kg per day for 5 days), or IV anti-D (50-75 µg/kg once) where available, may be appropriate in patients with bleeding, at high risk for bleeding, who require a surgical procedure, or who are unresponsive to prednisone/prednisolone. If using anti-D, exercise consideration over potential triggering of disseminated intravascular coagulation (DIC) or hemolysis, and consider steroid premedication to minimize acute infusion reactions (eg, headaches, fever-chills, and/or intravascular hemolysis).
  • Patients with contraindications to high-dose corticosteroid therapy (eg, insulin-dependent diabetes, uncontrolled diabetes, psychiatric disorders, active infection) may be managed with only IVIZG or IV anti-D as initial therapy.
  • TPO receptor agonists (TPO-RAs) and rituximab are not considered initial therapies.

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