Volumen: 18 # Number : 2
Publication Date : Mayo - Agosto Year: 2014
Second-line treatment
in adult Inmune Thrombocytopenia
Authors: Carlos G. Fondevila
Abstract: The treatment of immune thrombocytopenia (ITP) in adults has been based for decades on steroids as the initial step followed by splenectomy (S) in those unresponsive, relapsing or with side effects. A variety of immunosuppressive
and chemotherapy treatments were reserved for patients not responsive to S. Awareness about early and late complications of S as well as data on loss of the initial response and the appearance of rituximab (R) and of the thrombopoietin receptor agonists (TPORA) prompted a reconsideration of the best second-line therapy. This resulted in the publication of two international recent guidelines: they both agree on the recommendation of steroids as a first-line option and TPORA as third-line treatment, after S failure. With respect to the best second-line treatment after steroid failure, the guidelines did not agreed. While the ASH guideline still lists S preceding R and TPORA, the Internatiomal Consensus Report considers S at the same level of all the other second-line treatments
including R and TPORA. Information regarding the long term efficacy and sequelae of R and TPORA is steadily accumulating, allowing a more evidence-based choice between one agent versus the other or S. Meanwhile,
the insufficient evidence and the disagreement among experts suggest that management of ITP after steroid failure should be tailored on a patient to patient basis. Some clues, when present in the individual patient will assist the hematologist to guide the selection of one agent over the other two.
Key words: ITP, immune thrombocytopenia,
splenectomy, rituximab,
thrombopoietin receptor agonists,
eltrombopag, romiplostim
Pages : 133-139
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