title: Combination therapy in relapsed or refractory chronic immune thrombocytopenia: a case report and literature review.
abstract: OBJECTIVE
  Immune destruction and decreased platelet production are major components of immune thrombocytopenia (ITP) pathogenesis. The aim of this study was to critically evaluate the role of combination therapy in relapsed/refractory ITP and the concept of medication tapering/discontinuation.
  
  
  CONCLUSIONS
  Although a number of combination regimens have been reported, little is published on combining immunosuppression with thrombopoietin receptor agonists (TPO-RAs). We report a case of refractory ITP successfully treated with combination immunosuppression added to eltrombopag. An aggressive combination approach resulted in complete remission and allowed for stepwise drug tapering.
  
  
  CONCLUSIONS
  Combination immunosuppression can potentiate the effect of TPO-RAs. This mechanistically reasonable strategy could result in a more rapid response than the more popular, sequential, single-agent strategy. Stepwise tapering can be successfully implemented. Comparing sequential single-agent therapy with early combination approach warrants a more extensive study.
authors.affiliation: Department of Medicine, Divisions of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: A
authors.initials: A
authors.lastname: Rashidi
authors.affiliation: Department of Medicine, Division of Hematology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Blinder
mesh_terms: D002908:Chronic Disease / Q000188:drug therapy*; D003131:Combined Modality Therapy / Q000379:methods; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053628:Receptors, Thrombopoietin / Q000819:agonists; D013921:Thrombocytopenia / Q000188:drug therapy* / Q000276:immunology
chemical_list: D007166:Immunosuppressive Agents; D053628:Receptors, Thrombopoietin
keywords: eltrombopag; immune thrombocytopenia; immunosuppression; refractory; thrombopoietin