Management of adults with ITP who are corticosteroid dependent or has no response to steriod

In adults with ITP for 3 months or not responded to steriod

SECOND-LINE THERAPIES: SPLENECTOMY, TPO-RA, AND RITUXIMAB

Recommendation

In adults with ITP lasting 3 months who are corticosteroid-dependent or have no response to corticosteroids, the ASH guideline panel suggests either splenectomy or a TPO-RA (conditional recommendation based on very low certainty in the evidence).

Recommendation . In adults with ITP lasting 3 months who are corticosteroid-dependent or have no response to corticosteroids, the ASH guideline panel suggests rituximab rather than splenectomy (conditional recommendation based on very low certainty in the evidence of effects ).

Recommendation . Inadults with ITP lasting 3 months who are corticosteroid-dependent or have no response to corticosteroids, the ASH guideline panel suggests a TPO-RA rather than rituximab (conditional recommendation based on very low certainty in the evidence of effects).

Remark:

Each of these secondline treatments may be effective therapy and therefore the choice of treatment should be individualized based on duration of ITP, frequency of bleeding episodes requiring hospitalization or rescue medication, comorbidities, age of the patient, medication adherence, medical and social support networks, patient values and preferences, cost, and availability.

Patient education and shared decision-making are encouraged. If possible, splenectomy should be delayed for at least 1 year after diagnosis because of the potential for spontaneous remission in the first year.

Patients who value avoidance of long-term medication may prefer splenectomy or rituximab. Patients who wish to avoid surgery may prefer a TPO-RA or rituximab. Patients who place a high value on achieving a durable response may prefer splenectomy or TPO-RAs.