Immune Thrombocytopenia Treatment: Managing Immune Thrombocytopenia Through Different Treatment Approaches
Immune Thrombocytopenia Treatment, is an autoimmune bleeding disorder characterized by low platelet count in the blood. In ITP, the immune system mistakenly attacks and destroys platelets, which are essential for normal blood clotting and stopping bleeding. The exact cause of ITP is unknown but it is believed to be triggered by viral infections, vaccinations or certain medications in some cases. ITP can develop at any age but it is most common in children and older adults.
First Line Immune Thrombocytopenia Treatment Options for Newly Diagnosed ITP
The first-line treatment options for newly diagnosed ITP depend on factors like age of the patient and severity of symptoms. For children and most adults with mild asymptomatic ITP, initially a watch-and-wait approach is followed to see if the platelet counts improve on their own over time. For those with active bleeding or a very low platelet count, initial treatment aims to raise platelet counts through medications.
Corticosteroids:
Corticosteroids like prednisone are usually the first choice for treating symptomatic ITP. They work by suppressing the immune system and decreasing the breakdown of platelets. Short courses of high-dose prednisone are often effective in rapidly raising platelet counts within a week. However, steroids have side effects if used long term.
Intravenous Immunoglobulin (IVIG):
For patients who do not respond adequately to or cannot tolerate steroids, IVIG treatment involves infusion of antibodies collected from donated blood. IVIG treatment increases platelet counts within 3-7 days in about 70% of cases. It has less side effects than steroids but the responses are usually temporary and repeat treatments may be required.
Anti-D Immunoglobulin:
Rh-positive pregnant women or those at risk of Rh hemolytic disease may be given anti-D immunoglobulin. It contains antibodies against the RhD antigen that can reduce platelet destruction. A single injection of anti-D immunoglobulin may increase platelet counts for up to 2 months in those who respond to treatment.
Refractory ITP: Additional Treatment Approaches
While steroids and IVIG can successfully treat newly diagnosed ITP, some patients may experience relapses or become refractory to first-line treatments over time. In such cases of long-standing refractory ITP, additional treatment approaches are explored like splenectomy, thrombopoietin receptor agonists, rituximab or chemotherapy.
Splenectomy:
Removal of the spleen, known as splenectomy, can induce long-term remission in up to 70% of refractory ITP patients. As the spleen is the site of antibody production and platelet destruction in ITP, its removal eliminates this process. However, there are risks of surgery and complications.
Thrombopoietin Receptor Agonists:
Drugs like eltrombopag and romiplostim work by binding to and activating thrombopoietin receptors on bone marrow cells, stimulating platelet production. They have been shown to be effective in raising platelet counts in chronic ITP when other options have failed or cannot be used. Monthly shots of romiplostim under the skin are commonly prescribed.
Rituximab:
This monoclonal antibody targets and depletes B lymphocytes involved in antibody production. Studies show rituximab helps achieve a durable long-term remission in up to 60% of refractory ITP patients when used alone or along with other therapies like steroids. It may take up to 6 months to see effects.
Chemotherapy:
Strong immunosuppressive chemotherapy drugs like vincristine, cyclophosphamide or combinations including steroids are sometimes used for very severe refractory ITP after other treatments fail. They provide remission in 50-80% of such critical cases but major side effects are a concern with chemotherapy.
The Immune Thrombocytopenia Treatment approaches requires balancing benefits and risks to effectively manage symptoms and raise platelet counts to safe levels in the short and long-run. With multiple options available, healthcare providers work together with patients to determine optimal individualized strategies. Ongoing research continues to explore novel therapies for difficult to treat ITP.
*Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
