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 (in the UK), nor does it indicate the order in which treatments may be used.
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 |
|
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 |
|
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 |
|
Nplate (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 Administered Orally |
Stimulate platelet production |
Abnormal loss of weight; alopecia; anaemia; anxiety; appetite abnormal; arthralgia; asthenia; cataract; chest discomfort; chills; concentration impaired; confusion; constipation; cough; depression; diarrhoea; dizziness; drowsiness; dry eye; dry mouth; dysphagia; dyspnoea; eye discomfort; eye disorders; fever; gastrointestinal discomfort; gastrointestinal disorders; haemolytic anaemia; haemorrhage; headaches; hepatic disorders; hyperbilirubinaemia; hyperglycaemia; hypoglycaemia; increased risk of infection; influenza like illness; iron overload; lymphopenia; malaise; memory loss; menorrhagia; mood altered; muscle complaints; nasal complaints; nausea; neutropenia; oedema; oral disorders; oropharyngeal complaints; pain; palpitations; QT interval prolongation; sensation abnormal; skin reactions; sleep disorders; splenic infarction; sweat changes; syncope; taste altered; urine discolouration; vertigo; vision disorders; vomiting; weight decreased |
|
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 |
|
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 |