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ITP Treatment Options

Goals of treatment

Once other conditions that may cause low platelets are ruled out, and a diagnosis of ITP is made, a treatment plan can be developed based on the patient's complete medical condition and lifestyle.1

The first goal of ITP treatment is to lower the chances of uncontrolled bleeding (including internal bleeding) by raising the platelet count to a level where the chance of uncontrollable bleeding is low. Not all patients experience bleeding symptoms at the same platelet count and some patients may have no bleeding symptoms or only very mild symptoms at low platelet counts.2 Generally, doctors want to raise platelet levels over 50,000 per microliter of blood. At this platelet count the risk of uncontrolled bleeding is thought to be low for all patients. Another treatment goal may be to alleviate the ITP Symptoms and Signs (such as bruising).

The first goal of ITP treatment is to lower the chances of uncontrolled bleeding by raising the platelet count.

Because ITP is due to increased platelet destruction and decreased platelet production, treatments that help to manage ITP work on these processes.

What do patients with chronic ITP say?

Making decisions together:

  • 67% (389 out of 581 patients) of people with ITP would prefer their physician to discuss multiple therapies with them and then decide together on a particular treatment.3

To help you start this conversation, click here for 5 Things to Tell Your Doctor.

Types of treatment

Medical treatments that slow platelet destruction

In ITP, the body's immune system, for unknown reasons, destroys healthy blood platelets. It also impairs the body's ability to produce platelets. Slowing the destruction of platelets is one approach to ITP treatment. Most treatments for ITP interfere with the immune system to help reduce platelet destruction. Some of these treatments are FDA approved for ITP and some are not. Many of these treatments are immunosuppressants.4

  • Corticosteroids: Often the first treatment a patient receives, corticosteroids raise platelet counts by slowing the immune system's ability to clear platelets from the bloodstream.5 In fact, a positive response to corticosteroids can be used to confirm the diagnosis of ITP.6 A panel of ITP experts recently suggested that patients should only be on corticosteroids for 4 weeks as patients often experience complications because of their corticosteroids medicines over time.4
  • Anti-D and IVIG: These blood products include antibodies that are made from human plasma. They slow the clearance of platelets from the bloodstream,5,7 tend to be used when platelet counts are dangerously low, and have an effect that is usually temporary.1
  • Anti-CD20: Treatment with antibodies that bind to the CD20 antigen on malignant human B cells marks these cells for destruction by the immune system.5
  • Several other medications are used to treat ITP, including other immunosuppressants, hormone therapies, chemotherapeutics, and biologics.5

Medical treatments that increase platelet production

In recent years, it has become clearer that there is an additional process involved in ITP: The body doesn’t produce enough platelets to make up for the healthy platelets that are destroyed. An alternative approach works to increase platelet production4—supporting a normal process in the body.

Platelet boosters. These are medicines that do not work on the immune system, but instead imitate thrombopoietin, or TPO. TPO is the protein that tells special cells in the bone marrow called megakaryocytes to produce platelets. By doing this, platelet boosters help increase platelet production.4,5

How platelet boosters work
TPO helps cells in the bone marrow called megakaryocytes make platelets Platelet boosters stimulate megakaryocytes to produce platelets Platelet boosters help the body increase the number of platelets
A protein in your body called TPO helps cells in the bone marrow called megakaryocytes make platelets. Adult patients with ITP have less TPO than they need.8,9 Platelet boosters mimic the body's TPO. They stimulate megakaryocytes to produce platelets.4,7 Platelet boosters help the body increase the number of platelets to overcome the loss of platelets caused by ITP.4,7

Click here to read more about what experts say about platelet boosters, also called TPO-receptor agonists. Please note: if you click this link, you will
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Splenectomy: surgical treatment that slows the removal of platelets

Splenectomy is the permanent surgical removal of the spleen. The spleen is a part of the immune system that removes aging or defective blood cells, including platelets, makes some antibodies, and removes any cells or bacteria that are coated with antibodies from the body.10 Without the activities of the spleen, platelets are likely to stay in the blood longer. However, the spleen has other immune functions that your doctor may consider when deciding if a splenectomy is recommended.11 A panel of ITP experts recommended that most patients should wait at least 6 months after diagnosis before having a splenectomy because of patient preferences or the possibility of remission of symptoms on their own.4 You should discuss all available options with your healthcare provider.

The International Consensus Report, published in January 2010, was written by a panel of ITP experts. It recommends several treatment options after an insufficient response to corticosteroids. These treatment options include immunosuppressants, platelet boosters, or splenectomy.4

Different treatments for ITP have various benefits and risks. Always follow the recommendations of your healthcare professional.

 

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References:

  1. British Society for Haematology. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Brit J Haematol. 2003;120(4):574-596.
  2. George JN, Woolf SH, Raskob GE, et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood. 1996;88(1):3-40.
  3. Harris Interactive ITP Patient Survey Results. Data on file. Amgen Inc. December 16, 2008.
  4. Provan D, Stasi R, Newland AC, et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood. 2010;115:168-186.
  5. Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Engl J Med. 2002;346(13):995-1008.
  6. Cines DB, Bussel JB. How I treat idiopathic thrombocytopenic purpura. Blood. 2005;106(7):2244-2251.
  7. Cines DB. Pumping out platelets. Blood. 2007;109(11):4591-4592.
  8. Emmons RVB, Reid DM, Cohen RL, et al. Human thrombopoietin levels are high when thrombocytopenia is due to megakaryocyte deficiency and low when due to increased platelet destruction. Blood. 1996;87:4068-4071.
  9. Nichol JL. Endogenous TPO (eTPO) levels in health and disease: possible clues for therapeutic intervention. Stem Cells. 1998;16(suppl 2):165-175.
  10. Harrison’s Principles of Internal Medicine. 17th ed. New York: McGraw-Hill. Chapter 60. Available from McGraw-Hill’s AccessMedicine: http://www.accessmedicine.com. Accessed August 9, 2009.
  11. Merck Manual Home Edition. Spleen Disorders. http://www.merck.com/mmhe/sec14/ch179/ch179a.html. Accessed April 14, 2009.
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