ITP Support Association

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Summary of Treatments for ITP

PLEASE NOTE. This Treatment Table was compiled with the assistance of the ITP Support Association’s medical advisors and is intended as a quick reference guide listing the common and less common treatments for ITP. Not all the drugs on this list are necessarily right for every ITP patient – for example some with unpleasant side effects might only be used where a patient has very severe symptoms. It is not intended as a prescription list to take to your consultant and to be worked through from top to bottom! Neither does it include the ‘no treatment’ approach often recommended, particularly for children and adults with mild or unsymptomatic ITP. Being mentioned in the list does not indicate if a treatment is licensed or has NICE approval.

Orally - by mouth, Intravenously - into the vein, Subcutaneously - under the skin

Treatment	How it Works	Main Side Effects
Steroid (Prednisolone, Methylprednisolone, Dexamethasone) Administered Orally	Suppress immune system; decrease platelet destruction	Short-term: Common: irritability, anxiety, insomnia Rarely: gut bleeding, disseminated chickenpox (if recent contact and non-immune) Longer-term: Common: weight gain, muscle weakness, bone loss, visual problems, increased risk for infection Rarely: diabetes, cataracts
Intravenous Immunoglobulin (Ivig) Administered Intravenously	Block platelet destruction	Common: fever, chills, headache Rarely: meningitis-like reaction
Anti-D Administered Intravenously	Block platelet destruction in the spleen	Common: fever, chills, headache, mild haemolysis Rarely: severe haemolysis
Splenectomy Surgery	Remove the major site of platelet destruction	Surgical complications in 10%, death in 0.2-1 %, treatment failure in 33%. Long-term: increased risk for infection and thrombosis (heart attack, stroke, lung disease)
Danazol Administered Orally	Suppress immune system; decrease platelet destruction	In women: male pattern hair growth. In all patients: liver function abnormalities
Dapsone Administered Orally	Unknown	Anaemia; skin rash
Azathioprine Administered Orally	Suppress immune system; decrease platelet destruction	Increased risk for infection
Cyclophosphamide Administered Intravenously	Suppress immune system; decrease platelet destruction	Increased risk for infection, urinary bladder inflammation, hair loss, possible infertility in men and women
Vincristine or Vinblastine Administered Intravenously	Suppress immune system; decrease platelet destruction	Hair loss, muscle pain, neuropathy (numbness, weakness of arms and legs), increased risk for infection
Mycophenolate Administered Orally	Suppress immune system; decrease platelet destruction	Nausea, diarrhoea; increased risk for infection
Plasmapheresis Intravenous Blood Filtration	Removal of antibodies from blood	None. May need surgical line to be inserted with risk of local infection or thrombosis (yes even in ITP!)
Cyclosporine Administered Orally	Suppress immune system; decrease platelet destruction	Tremor, impaired kidney function; high blood pressure, increased risk for infection Increased hair growth
Rituximab Administered Intravenously	Suppress immune system; decrease platelet destruction	Common: Fever, chills, rash with infusion. Possible increased risk for infection Rarely: may cause severe allergic reaction, late allergic arthritis or kidney failure
Helicobacter Pylori Treatment Administered Orally	Eradication may remove a stimulus for ITP	Allergic reactions to the medicines (rare)
Vitamin C Supplements Administered Orally	Unknown	Potential increased risk for kidney stones with high doses
Nplate (Was Amg 531 Romiplostin) Administered Subcutaneously	Stimulate platelet production	No important side effects recognized in current clinical trials. Rare patients developed marrow fibrosis in early studies with higher doses than currently allowed
Eltrombopag to be called Revolade in the UK, Promacta in the USA Administered Orally	Stimulate platelet production	No important side effects recognized in current clinical trials. Theoretical risk of cataracts and marrow fibrosis
Platelet Transfusion Administered Intravenously	Platelet supplementation (transient response as antibodies may clear donated platelets within minutes- usually reserved for life-threatening bleeds in conjunction with other therapy)	Fever, chills (uncommon); transfusion- transmitted infection (very rare)
Tranexamic Acid Administered Orally	Used to aid clotting	Nausea, diarrhoea, vomiting, disturbance of colour vision