What are the American Society of Hematology (ASH) guidelines for second-line treatment of immune thrombocytopenia (ITP) in adults?

Updated: Dec 14, 2019
  • Author: Michael A Silverman, MD, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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Recommended second-line treatments for cases that do not respond to corticosteroids, or recur afterward, are as follows, in order of preference [7] :

  • A TPO-RA (eltrombopag or romiplostim)
  • Rituximab
  • Splenectomy

Increasingly, clinicians are trying TPO-RAs before referring patients for splenectomy.  According to published data, 25–30% of patients who are treated with TPO-RAs have a sustained response after stopping the drug. The mechanism for these sustained responses is not known. Spontaneous remission is unlikely as an explanation, as the patients in reported studies had all received several prior treatments and had severe, prolonged thrombocytopenia. [9]

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