[New treatment methods for autoimmune thrombocytopenia].
--For many years, splenectomy has been considered the only therapy with proven efficacy in patients with relapsed/refractory idiopathic thrombocytopenic purpura (ITP) following corticosteroid therapy. --A broad spectrum of (mostly immunosuppressive) agents are available for patients who fail to respond to splenectomy. However, the risks associated with these agents sometimes outweigh their benefits. --Recently, several new or renewed strategies have been evaluated for chronic refractory ITP. --Short-term therapy with high-dose dexamethasone is an effective alternative to long-term treatment with corticosteroids. --Depletion of B lymphocytes with rituximab, an agent that has an established role in the treatment of non-Hodgkin's lymphoma, also appears to be effective in autoimmune disorders, particularly in ITP. --Although the main problem in ITP is the increased destruction of thrombocytes, stimulation of thrombocyte production with thrombopoietin(TPO)-receptor agonists can increase thrombocyte counts. --Two TPO-receptor agonists, AMG531 and eltrombopag, induce responses in 70-80% of ITP patients and are expected to gain approval for use in ITP soon.
Koene
H R
HR
Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Klinische Hematologie. h.koene@antonius.net
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000628:therapy*; D053628:Receptors, Thrombopoietin / Q000819:agonists*; D000069283:Rituximab; D013156:Splenectomy; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D053628:Receptors, Thrombopoietin; C082218:MPL protein, human; D000069283:Rituximab