ASH Recommends Limited Prednisone Use for Newly Diagnosed Adult ITP
New guidelines from the American Society of Hematology (ASH) recommend treating newly diagnosed adults with Idiopathic Thrombocytopenic Purpura (ITP) with prednisone for no more than six weeks. ITP is a blood disorder causing low platelet counts, leading to increased bleeding risks.
ITP treatments aim to stabilize and boost platelet counts, reducing bleeding risks and symptoms like bruising. First-line therapies include corticosteroids like prednisone and dexamethasone. Other options include thrombopoietin receptor agonists such as Eltrombopag, Romiplostim, and Avatrombopag, intravenous immunoglobulins (IVIG), and Rituximab, an anti-CD20 antibody. Fostamatinib, a spleen tyrosine kinase inhibitor, and immunosuppressants like Azathioprine or Cyclophosphamide are used when initial therapies fail.
Rituximab works by destroying abnormal B cells attacking platelets. Corticosteroids have been used for over 30 years, with high dose dexamethasone and oral prednisone being common. Thrombopoietin receptor antagonists like Eltrombopag and Romiplostim stimulate platelet production. IVIG infusions can quickly increase platelet counts, useful before surgeries. A splenectomy may be considered when medications aren't effective, but it carries infection risks.
ASH's 2019 guidelines emphasize limited prednisone use for newly diagnosed adult ITP patients. Effective treatments can manage platelet counts, reduce bleeding risks, and improve quality of life. However, each therapy has its pros and cons, and individual patient needs should guide treatment decisions.
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