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ITP Management Is Slowly Evolving With Novel Agents

Caroline Seymour
Published: Tuesday, Sep 18, 2018

Abhinav Deol, MD

Abhinav Deol, MD

Steroids, though not always sustainable, are the standard first-line treatment for idiopathic thrombocytopenic purpura (ITP), followed by immunomodulatory (IMiD) treatments and thrombopoietin mimetic stimulatory agents, explained Abhinav Deol, MD.

, Deol, assistant professor of oncology, Division of Hematology and Oncology, Department of Oncology, Wayne State University School of Medicine, Karmanos Cancer Institute, discussed the presentation and prevalence of ITP in addition to the current and emerging therapeutic strategies that are used to manage the disease.

OncLive: How does ITP present and who is most likely to be diagnosed with the disease?

Deol: In its name it says idiopathic, so we don't have a clear-cut cause in terms of the low platelet count, which leads to increased risk for bleeding. Sometimes this can happen after patients have been exposed to certain drugs. This might stimulate their immune system to target normal cells like platelets. Usually, it is a diagnosis of exclusion. You want to make sure there are no other abnormalities that are leading to low platelet counts including autoimmune diseases and other problems that can coexist. We diagnose someone with ITP if there is no evidence of any other existing condition and there are no infections that can explain the low platelet count.

The treatment for this has been evolving over the last few years. The cornerstone of treatment was immune suppression with steroids or immunoglobulins, though that is usually not something that is sustainable for a long period of time. Steroids have their own adverse events. Immunoglobulin responses usually last for a short period of time. That is where other treatments, such as rituximab (Rituxan), have been used in this setting. We also have thrombopoietin mimetic stimulatory agents, such as eltrombopag and romiplostim, that have been approved. More recently, there is a SYK inhibitor that was approved for use in patients with ITP who don't respond to other IMiD approaches.

What is the prevalence of ITP?

It's not something that we see very commonly, but it does happen. There is a slight female preponderance. Some of the developing countries have also shown that there might be a coexistence with some common infections. Some European studies from Italy looked at common pathogens that cause acid reflux, which might be associated with ITP incidence.
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