In 2019 the American Society of Hematology (ASH) and the International Consensus Report (ICR) released updates to their guidelines for ITP treatment. These updates are based on a critical review of relevant articles published over the last 10 years.1,2
Recent evidence suggests that ITP is often managed with prolonged steroid use, exposing patients to side effects that may have long-term implications.1
of steroid treatment
is preferred vs prolonged, continuous use
Delay splenectomy until after 1 year
of steroid treatment (8 weeks max)
in patients who achieve a response even if platelet counts drop during taper
Delay splenectomy until ≥ 1 year to 2 years
ASH ITP guidelines suggest a TPO-RA, including Nplate®, as a second-line therapy over rituximab1,3,*
*Rituximab is not FDA-approved for use in ITP. 4
ITP, immune thrombocytopenia; TPO-RA, thrombopoietin receptor agonist.
Nplate® administration may increase the risk for development or progression of reticulin fiber formation within the bone marrow. This formation may improve upon discontinuation of Nplate®. In a clinical trial, one patient with ITP and hemolytic anemia developed marrow fibrosis with collagen during Nplate® therapy.
Nplate® is a thrombopoietin receptor agonist indicated for the treatment of thrombocytopenia in adult patients with immune thrombocytopenia (ITP) who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy. Nplate® is indicated for the treatment of thrombocytopenia in pediatric patients 1 year of age and older with ITP for at least 6 months who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy.
Nplate® is not indicated for the treatment of thrombocytopenia due to myelodysplastic syndrome (MDS) or any cause of thrombocytopenia other than ITP. Nplate® should be used only in patients with ITP whose degree of thrombocytopenia and clinical condition increase the risk for bleeding. Nplate® should not be used in an attempt to normalize platelet counts.
References: 1. Provan D, Arnold DM, Bussel JB, et al. Updated International Consensus Report on the investigation and management of primary immune thrombocytopenia. Blood Adv. 2019;3(22):3780-3817. 2. Neunert C, Terrell DR, Arnold DM, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019;3(23):3829-3866. 3. Nplate® (romiplostim) prescribing information, Amgen. 4. RITUXAN® (rituximab) full Prescribing Information, Genentech, Inc.