title: Is there still a place for "old therapies" in the management of immune thrombocytopenia?
abstract: New molecules such as rituximab or thrombopoietin receptor agonists (romiplostim and eltrombopag) have changed the management of immune thrombocytopenia. Therefore, old drugs which are less expensive and with a well-known benefit/risk ratio are being underused. We aim to define the place of dapsone, danazol, hydroxychloroquine and vinca-alkaloids at the era of targeted therapy in immune thrombocytopenia. With a response rate around 30% to 50%, dapsone is an interesting second-line therapy to be used just after corticosteroids. Patients with positive antinuclear antibodies can benefit from hydroxychloroquine with a 50% response rate. Because of its side effects, mostly virilization, danazol will be preferentially used in the elderly. Vinca-alkaloids could be temporarily used in patients that do not respond to intravenous immunoglobulins or to limit their use to avoid shortage periods.
authors.affiliation: Service de Médecine Interne et Immunologie Clinique, Centre de Compétences des cytopénies auto-immunes de l'adulte, Hôpital Bocage Central, 14, rue Paul-Gaffarel, 21000 Dijon, France; CR INSERM 1098, Bâtiment B3, rue Angélique-Ducoudray, 21000 Dijon, France. Electronic address: sylvain.audia@u-bourgogne.fr.
authors.forename: S
authors.initials: S
authors.lastname: Audia
authors.affiliation: Service de Médecine Interne, Centre de Référence des cytopénies auto-immunes, Hôpital Henri-Mondor, AP-HP, UPEC, 94000 Créteil, France.
authors.forename: B
authors.initials: B
authors.lastname: Godeau
authors.affiliation: Service de Médecine Interne et Immunologie Clinique, Centre de Compétences des cytopénies auto-immunes de l'adulte, Hôpital Bocage Central, 14, rue Paul-Gaffarel, 21000 Dijon, France; CR INSERM 1098, Bâtiment B3, rue Angélique-Ducoudray, 21000 Dijon, France.
authors.forename: B
authors.initials: B
authors.lastname: Bonnotte
mesh_terms: D001565:Benzoates / Q000627:therapeutic use; D003613:Danazol / Q000627:therapeutic use; D003622:Dapsone / Q000627:therapeutic use; D006801:Humans; D006834:Hydrazines / Q000627:therapeutic use; D006886:Hydroxychloroquine / Q000627:therapeutic use; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000453:epidemiology / Q000628:therapy*; D011720:Pyrazoles / Q000627:therapeutic use; D011961:Receptors, Fc / Q000627:therapeutic use; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D000069283:Rituximab / Q000627:therapeutic use; D013926:Thrombopoietin / Q000627:therapeutic use; D014748:Vinca Alkaloids / Q000627:therapeutic use
chemical_list: D001565:Benzoates; D006834:Hydrazines; D016756:Immunoglobulins, Intravenous; D011720:Pyrazoles; D011961:Receptors, Fc; D011993:Recombinant Fusion Proteins; D014748:Vinca Alkaloids; D000069283:Rituximab; D006886:Hydroxychloroquine; D003622:Dapsone; D013926:Thrombopoietin; C488777:romiplostim; D003613:Danazol; C520809:eltrombopag
keywords: Danazol; Dapsone; Hydroxychloroquine; Immune thrombocytopenia; Vinca-alkaloids