title: Sequence of treatments for adults with primary immune thrombocytopenia.
abstract: 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.
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73190, USA. james-george@ouhsc.edu
authors.forename: James N
authors.initials: JN
authors.lastname: George
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D008297:Male; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D053628:Receptors, Thrombopoietin / Q000819:agonists; D012074:Remission Induction; D000069283:Rituximab; D013156:Splenectomy
chemical_list: D000305:Adrenal Cortex Hormones; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D053628:Receptors, Thrombopoietin; C082218:MPL protein, human; D000069283:Rituximab