title: Immune thrombocytopenia -- what are the new treatment options?
abstract: BACKGROUND
  Primary immune thrombocytopenia (ITP) is a minor disease for many patients; however, the natural history is variable and unpredictable. Many patients who are in otherwise good health can be left untreated, especially if their platelet counts are close to 20 × 10(9)/l. The overall mortality rate for ITP is < 1%, and the morbidity and mortality associated with treatment can be worse than the disease.
  
  
  METHODS
  ITP is not purely due to platelet destruction and in a significant proportion platelet production is sub-optimal; the review will cover the newer developments with the thrombopoietin receptor agonists (TPOrAs) of which two agents, romiplostim and eltrombopag, are now licensed and these will be placed in context to conventional treatment.
  
  
  CONCLUSIONS
  There is an increasing understanding of the natural history of ITP and an increasing evidence-based approach to the disease and its management. Treatment should be aimed at the patient with a bleeding risk and should minimise the risk of adverse effects while maximising the chances of response. Few, if any, treatments are curative and treatment strategies need to be designed in ITP that manage patients with what can be a life-long condition with periodic relapses.
authors.affiliation: Queen Mary University of London, Bart's & The London School of Medicine and Dentistry, Department of Haematology, Whitechapel, London El 2ES, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Hallam
authors.forename: Drew
authors.initials: D
authors.lastname: Provan
authors.forename: Adrian C
authors.initials: AC
authors.lastname: Newland
mesh_terms: D001565:Benzoates / Q000627:therapeutic use*; D019468:Disease Management; D006801:Humans; D006834:Hydrazines / Q000627:therapeutic use*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000628:therapy*; D011720:Pyrazoles / Q000627:therapeutic use*; D011961:Receptors, Fc / Q000627:therapeutic use*; D053628:Receptors, Thrombopoietin / Q000819:agonists; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D013926:Thrombopoietin / Q000627:therapeutic use*
chemical_list: D001565:Benzoates; D006834:Hydrazines; D011720:Pyrazoles; D011961:Receptors, Fc; D053628:Receptors, Thrombopoietin; D011993:Recombinant Fusion Proteins; D013926:Thrombopoietin; C488777:romiplostim; C520809:eltrombopag