Below are the general types of ITP treatments often suggested by hematologists. No one treatment works for everyone and treatments from different categories are sometimes combined to increase overall effectiveness. There is currently no way to predict which treatment will work for any one person. However, researchers are investigating this very important topic.
The treatments are listed by functional category. There are at least three ways to reference each medical treatment: the category, the generic name, and the brand name (which differs by country or region). Generic and brand names as well as details about dosage, side effects, and efficacy are referenced in the linked pages.
The treatment information does not represent an endorsement by PDSA or its medical advisors. For advice on your unique medical condition, please consult your health care provider.
An ITP diagnosis is sometimes associated with an infection and antibiotics can raise the platelet count. There has been considerable research on the success of antibiotics used to treat H-pylori in those diagnosed with ITP. The eradication of other infections can also raise the platelet count.
Used to achieve a temporary elevation of the platelet count, the treatment can be repeated for a more extended remedy. The shorter infusion time and often lower cost is an advantage over IVIg. Win Rho SDF and Rhophylac are approved for the treatment of ITP in the US.
B-cell depletion by a monoclonal antibody (anti-CD20, rituximab) has not been approved by the FDA to treat ITP, although it has become a widely used treatment choice. It works by disabling and changing B-cells, a type of white blood cell. Other anti-CD20 options are in clinical trials.
Various chemotherapy drugs have been used as a second or third-line treatment choice for chronic ITP patients. Each has a slightly different side effect profile. They have been effective in a small percentage of cases and can be quite toxic. They have not been approved by the FDA to treat ITP.
Often the first-line treatment for ITP, the dose of corticosteroids (ex. Prednisone) is initially quite high then gradually tapered. Sometimes the platelets remain elevated but in most cases the platelet count recedes as the dose is reduced. An alternate method of administering corticosteroids is an extremely high dose for a few days with no taper. The side effects of corticosteroids can be uncomfortable and grow in severity if the treatment is continued for a long time. While the FDA mentions this as a first-line treatment, it has not been officially approved for the treatment of ITP.
An IV drip of immunoglobulin, a type of antibody, is also referred to as IVIg, IGG or IGIV. This treatment is a temporary measure and is not expected to result in a sustained, elevated platelet count, although in some rare cases this does happen. It can be repeated for longer lasting results. IVIg is manufactured by several companies, some of which have received FDA approval for its use in the treatment of ITP.
This class of drugs disables parts of the immune system and is often used to prevent the rejection of transplanted organs. These are second and third-line treatments for ITP and have been used to treat other autoimmune diseases such as MS and lupus. None have been approved by the FDA to treat ITP.
A synthetic androgen (male sex hormone) is sometimes used to treat ITP when other treatments have failed. It disrupts the action of the pituitary gland, reduces estrogen, halts menses and can cause masculine features for women.
The newest treatment approach for ITP is the use of platelet growth factors. These agents increase platelets by stimulating the bone marrow to produce more of them. Once thought to be only a disease of platelet destruction, recent research has shown that many people with ITP also have a platelet production problem. Nplate and Promacta have been approved for the treatment of ITP in this category.
This is a surgical procedure where the spleen is removed. The spleen is a large blood filter which, for many people, removes antibody-coated platelets. Theoretically, if the spleen is removed, the platelets will remain in circulation. However, there are other ways the body removes platelets, so this treatment sometimes fails to have a lasting effect.
More of a strategy than a treatment, ‘Watchful Waiting’ means choosing to live with your current, safe counts while carefully monitoring your disease and treatment options.
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