Dr. Altomare on the Challenges of Treating ITP

Ivy P. Altomare, MD, associate professor of medicine, Department of Medicine, Duke University School of Medicine, and medical oncologist, Duke Cancer Network, discusses some of the challenges of treating immune thrombocytopenia (ITP).

ITP requires a clinical diagnosis because there is no definitive test that can be used to diagnosis ITP, says Altomare. In addition to diagnosis, treatment for highly refractory patients with ITP can be challenging, explains Altomare. As the most effective agents are used upfront, there are limited options for patients who relapse.

Patients who have active bleeding or a strong risk of bleeding in addition to a blood clot are a particularly challenging group of patients to treat, says Altomare. In these cases, it is important to establish a balance between preventing thrombosis and preventing the risk of bleeding.

Thrombopoietin receptor agonists that are frequently utilized in the treatment of ITP predispose patients to deep vein thrombosis and venous thromboembolism (VTE), says Altomare.

However, fostamatinib disodium hexahydrate (fostamatinib; Tavalisse) does not appear to increase the risk of thrombosis and should be considered for patients who are at risk of developing VTE, concludes Altomare.