title: Second-line therapies in immune thrombocytopenia.
abstract: Immune thrombocytopenia (ITP) is a rare, acquired autoimmune condition characterized by a low platelet count and an increased risk of bleeding. Although many children and adults with ITP will not need therapy beyond historic first-line treatments of observation, steroids, intravenous immunoglobulin (IVIG), and anti-D globulin, others will have an indication for second-line treatment. Selecting a second-line therapy depends on the reason for treatment, which can vary from bleeding to implications for health-related quality of life (HRQoL) to likelihood of remission and patient preference with regard to adverse effects, route of administration, and cost. Published studies of these treatments are limited by lack of comparative trials, in addition to inconsistent outcome measures, definitions, and efficacy endpoints. This article provides an up-to-date comparison of the second-line treatments, highlighting important outcome measures including bleeding, HRQoL, fatigue, and platelet counts, which influence treatment selection in a shared decision-making model.
authors.affiliation: Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorder Center, Boston, MA; and.
authors.forename: Rachael F
authors.initials: RF
authors.lastname: Grace
authors.affiliation: Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Medical Center, New York, NY.
authors.forename: Cindy
authors.initials: C
authors.lastname: Neunert
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D006470:Hemorrhage / Q000097:blood / Q000191:economics / Q000517:prevention & control; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000191:economics / Q000627:therapeutic use*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D011788:Quality of Life; D018029:Rho(D) Immune Globulin / Q000191:economics / Q000627:therapeutic use*; D012307:Risk Factors
chemical_list: D016756:Immunoglobulins, Intravenous; D018029:Rho(D) Immune Globulin