Vol 11, No 2 (2020)
Review paper
Published online: 2020-09-02

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Pharmacological treatment of primary immune thrombocytopenia in adults

Krzysztof Chojnowski1
Hematologia 2020;11(2):73-81.

Abstract

The treatment goal in patients with primary immune thrombocytopenia (ITP) is to prevent severe bleeding, the risk of which is increased if the platelet count (PLT) remains below 20–30 G/L. First-line treatment includes corticosteroids and/or intravenous immunoglobulins, which are effective in 70–90% of patients. In most cases, initial treatment will not lead to a sustained increase in PLT. Further treatment may include pharmacotherapy or splenectomy. Of all the therapeutic options, splenectomy offers the best chance of a permanent cure. Moreover a lot of ITP patients do not agree to splenectomy and some patients have contraindications to the operation. These patients should be treated with a thrombopoietin receptor agonist or rituximab. Unfortunately, in Poland, these agents are not reimbursed by the National Health Fund in adult ITP patients with preserved spleen. For this reason, less effective and more toxic drugs are still used as a second-line treatment.

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