Initial Treatment for Newly Diagnosed ITP Patients at a Glance

• Corticosteroids remain the standard initial treatment for adult patients with ITP who need treatment and do not have any relative contraindications. Corticosteroids offer multiple benefits regarding the hemostatic effect on platelets by reducing platelet clearance and increasing their production. Additionally, they can directly reduce bleeding tendencies through their effect on blood vessels.
• The appropriate dose of corticosteroid is usually 1 mg/kg for prednisone, with a maximum dose of 80 mg (even for patients weighing > 80 kg) over a period of 2 weeks. The duration of use at this dose should not exceed 3 weeks. Longer use of corticosteroids brings several side effects, even when administered in relatively small doses (≤ 5 mg per day). This small dose has shown effects in some patients, but it is essential to carefully consider all risks and possible benefits of this therapy.
• If a response is observed (for example, an increase in platelet count to > 50 × 10⁹/l), the dose of corticosteroids should be gradually tapered, aiming to discontinue prednisone by the 6th week (up to a maximum of 8 weeks), even if the platelet count drops again.
• If no response is observed within the first 2 weeks, the corticosteroid should be rapidly tapered over a period of 1 week.
• The administration of intravenous immunoglobulins (IVIG) in a dose of 1 g/kg in 1 or 2 doses over 2 consecutive days, or in a dose of 0.4 g/kg daily for 5 days, is an option for patients with bleeding manifestations or a high risk of bleeding, or those needing surgical intervention.
• Patients with certain contraindications to high doses of corticosteroids (insulin-dependent diabetes mellitus, uncontrolled diabetes, psychiatric disorders, active infections, etc.) may be preferentially treated with IVIG.
• Thrombopoietin receptor agonists (TPO-RA) and rituximab are considered second-line treatments for newly diagnosed ITP.

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Source: Provan D., Arnold D. M., Bussel J. B. et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv 2019; 3 (22): 3780–3817, doi: 10.1182/bloodadvances.2019000812.