Summary of Treatments for ITP

PLEASE NOTE. This Treatment Table was compiled with the assistance of the ITP Support Association’s medical advisors and is intended as a quick reference guide listing the common and less common treatments for ITP. Not all the drugs on this list are necessarily right for every ITP patient – for example some with unpleasant side effects might only be used where a patient has very severe symptoms. It is not intended as a prescription list to take to your consultant and to be worked through from top to bottom! Neither does it include the ‘no treatment’ approach often recommended, particularly for children and adults with mild or unsymptomatic ITP. Being mentioned in the list does not indicate if a treatment is licensed or has NICE approval (in the UK), nor does it indicate the order in which treatments may be used.

Orally - by mouth, Intravenously - into the vein, Subcutaneously - under the skin

Treatment How it Works Main Side Effects

Steroid (Prednisolone, Methylprednisolone, Dexamethasone)

Administered Orally

Suppress immune system; decrease platelet destruction Short-term: Common: irritability, anxiety, insomnia Rarely: gut bleeding, disseminated chickenpox (if recent contact and non-immune) Longer-term: Common: weight gain, muscle weakness, bone loss, visual problems, increased risk for infection Rarely: diabetes, cataracts

Intravenous Immunoglobulin (Ivig)

Administered Intravenously

Block platelet destruction Common: fever, chills, headache Rarely: meningitis-like reaction

Anti-D

Administered Intravenously

Block platelet destruction in the spleen Common: fever, chills, headache, mild haemolysis Rarely: severe haemolysis

Rituximab

Administered Intravenously

Suppress immune system; decrease platelet destruction Common: Fever, chills, rash with infusion. Possible increased risk for infection Rarely: may cause severe allergic reaction, late allergic arthritis or kidney failure

Splenectomy

Surgery

Remove the major site of platelet destruction Surgical complications in 10%, death in 0.2-1 %, treatment failure in 33%. Long-term: increased risk for infection and thrombosis (heart attack, stroke, lung disease)

Danazol

Administered Orally

Suppress immune system; decrease platelet destruction In women: male pattern hair growth. In all patients: liver function abnormalities

Dapsone

Administered Orally

Unknown Anaemia; skin rash

Azathioprine

Administered Orally

Suppress immune system; decrease platelet destruction Increased risk for infection

Cyclophosphamide

Administered Intravenously

Suppress immune system; decrease platelet destruction Increased risk for infection, urinary bladder inflammation, hair loss, possible infertility in men and women

Vincristine or Vinblastine

Administered Intravenously

Suppress immune system; decrease platelet destruction Hair loss, muscle pain, neuropathy (numbness, weakness of arms and legs), increased risk for infection

Mycophenolate

Administered Orally

Suppress immune system; decrease platelet destruction Nausea, diarrhoea; increased risk for infection

Plasmapheresis

Intravenous Blood Filtration

Removal of antibodies from blood None. May need surgical line to be inserted with risk of local infection or thrombosis (yes even in ITP!)

Cyclosporine

Administered Orally

Suppress immune system; decrease platelet destruction Tremor, impaired kidney function; high blood pressure, increased risk for infection Increased hair growth

Nplate (Romiplostin)

Administered Subcutaneously

Stimulate platelet production No important side effects recognized in current clinical trials. Rare patients developed marrow fibrosis in early studies with higher doses than currently allowed

Eltrombopag
to be called Revolade in the UK, Promacta in the USA

Administered Orally

Stimulate platelet production No important side effects recognized in current clinical trials. Theoretical risk of cataracts and marrow fibrosis

Helicobacter Pylori Treatment

Administered Orally

Eradication may remove a stimulus for ITP Allergic reactions to the medicines (rare)

Vitamin C Supplements

Administered Orally

Unknown Potential increased risk for kidney stones with high doses

Platelet Transfusion

Administered Intravenously

Platelet supplementation (transient response as antibodies may clear donated platelets within minutes- usually reserved for life-threatening bleeds in conjunction with other therapy) Fever, chills (uncommon); transfusion- transmitted infection (very rare)

Tranexamic Acid

Administered Orally

Used to aid clotting Nausea, diarrhoea, vomiting, disturbance of colour vision

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