Immune thrombocytopenic purpura – current management practices
- 1 December 2004
- journal article
- review article
- Published by Informa Healthcare in Expert Opinion on Pharmacotherapy
- Vol. 5 (12), 2515-2527
- https://doi.org/10.1517/14656566.5.12.2515
Abstract
The treatment of patients with immune thrombocytopenic purpura (ITP) is changing rapidly, as new agents demonstrate the capability of improving outcomes and decreasing toxicity. Prior to 1981, the only effective treatment options available to increase platelet counts in persons with ITP were corticosteroids and splenectomy. In recent years, intravenous immunoglobulin (IVIg) and intravenous Rh immunoglobulin (IV RhIg) have demonstrated efficacy comparable to that of corticosteroids for increasing platelet counts in ITP. In addition, IVIg and IV RhIg have demonstrated efficacy for maintaining corticosteroid-induced increased platelet counts by periodic infusion, causing a transient impairment of reticuloendothelial clearance function (medical splenectomy). Thus, the time-proven efficacy of corticosteroids for initial treatment of ITP (induction) may now be supplemented with IVIg or IV RhIg infusions for patients requiring ongoing treatment to support a timely and complete steroid taper, while sustaining the increased platelet count (maintenance) with less toxicity. Several investigators have reported that rituximab (anti-CD20) induced sustained remissions with minimal toxicity, in patients with chronic ITP. These reports are promising and, if confirmed, will provide another effective (spleen-sparing) option for managing acute ITP and a long-awaited option for patients who have had a splenectomy and are refractory to conventional agents. Other treatments, including danazol, azathioprine, cyclophosphamide, vinca alkaloids and cyclosporin A, have advocates, but evidence of their efficacy is limited to relatively small and mostly uncontrolled clinical trials. In our opinion, these agents should be reserved for symptomatic thrombocytopenia after refractoriness to corticosteroids, IVIg, IV RhIg, splenectomy and rituximab has been clearly established.Keywords
This publication has 74 references indexed in Scilit:
- The IgG subclasses of platelet‐associated autoantibodies directed against platelet glycoproteins IIb/IIIa in patients with idiopathic thrombocytopenic purpuraBritish Journal of Haematology, 2003
- Platelet Recovery in Patients with Idiopathic Thrombocytopenic Purpura after Eradication of Helicobacter PyloriInternational Journal of Hematology, 2003
- Effect of Helicobacter pylori eradication on platelet recovery in Japanese patients with chronic idiopathic thrombocytopenic purpura and secondary autoimmune thrombocytopenic purpuraBritish Journal of Haematology, 2002
- Pathophysiology of platelet destruction in immune (idiopathic) thrombocytopenic purpuraBlood Reviews, 2002
- Immunodominant epitopes on glycoprotein IIb-IIIa recognized by autoreactive T cells in patients with immune thrombocytopenic purpuraBlood, 2001
- Autoantibodies to αIIbβ3 in patients with chronic immune thrombocytopenic purpura bind primarily to epitopes on αIIbBlood, 2001
- Regression of autoimmune thrombocytopenia after eradication of Helicobacter pyloriThe Lancet, 1998
- Correlation of platelet FcγRIIA polymorphism in refractory idiopathic (immune) thrombocytopenic purpuraBritish Journal of Haematology, 1998
- Quantitation of platelet‐specific autoantibodies in platelet eluates of ITP patients measured by a novel ELISA using the purified glycoprotein complexes GPIIb/IIIa and GPIb/IX as antigensBritish Journal of Haematology, 1997
- Mechanisms of Response to Treatment in Autoimmune Thrombocytopenic PurpuraNew England Journal of Medicine, 1989