Treatments for chronic immune thrombocytopenia (cITP) don’t work for everyone. If your first one isn’t right for you, you and your doctor have plenty of other options.

Choosing a Treatment

Doctors call treatments that work best first-line treatments. They’re usually the first ones you try.  If they don’t help your symptoms, your doctor will likely turn to second-line treatments. These may not work quite as well and can have more side effects.

Third-line treatments often aren’t as helpful or safe, so they’re tried last.  Your doctor may go through all the treatments in one group before moving on to the next. Or your doctor might combine treatments from different groups.  For example, you might take a steroid -- a first-line medicine -- with a second-line treatment.

First-Line Treatments

For cITP, these are corticosteroids (steroids) and immune globulin (IVIG or anti-D). Steroids do a good job of helping your body make more platelets, but you usually don’t take them for long because of their serious side effects.

Immune globulin comes from donated human blood. You get that through an IV. It stops bleeding fast. But it wears off fast, too.

Second-Line Treatments

When steroids and immune globulin don’t do the trick, these are usually the next things your doctor will try:

Thrombopoietin-receptor agonists (TPO-RAs):  These new medicines help your body make more platelets. There are two drugs in this class: romiplostim (Nplate) and eltrombopag (Promacta). You take Promacta as a pill every day. Nplate is given as a shot once a week. These meds may have milder side effects than many other cITP treatments, but can include:

  • A tired feeling
  • Blood clots 
  • Headaches

Avatrombopag (Doptelet): This is not a TPO-RA medication, but like TPO-RAs, it helps your body make more platelets and strengthens your immune system.

You’d take these pills daily for 5 days. Side effects, like in TPO-RAs, are mild and can include:

  • A tired feeling
  • Abdominal pain
  • Blood clots 
  • Fever
  • Headaches

Rituximab (Rituxan): Doctors use this medicine as a second-line treatment for cITP. It raises platelet counts for many people, but it comes with serious side effects, which can include:

  • Swelling of the tongue or throat
  • Chest tightness
  • Hives
  • Blurred vision
  • Blood in urine or stools
  • Black, tarry stools   

Tavalisse (fostamatinib): The FDA approved this drug for cITP in 2018. It’s a tablet you take twice a day. In clinical trials, it helped create more blood platelets for some people who weren’t helped by other second-line treatments.For most people, side effects are mild. But in rare cases it can make you less able to fight infection. It can also raise your blood pressure, and it could cause liver toxicity. Serious allergic reactions are also possible, but rare.

Splenectomy

This is surgery to remove your spleen.

Your spleen is an organ on the left side of your body, just below your ribs. It’s part of your immune system, and it helps fight infections. But if you have cITP, your spleen destroys platelets by mistake. If you don’t have a spleen, more platelets could stay in your blood. 

The surgery doesn’t always work, though. And there’s no way to know who it will help. You can have a healthy life without a spleen, but you’re more likely to get infections without one.  You also have a higher chance of heart attack and dementia. For most people, spleen surgery only happens after most other options haven’t worked.

How Your Next Treatment Is Chosen

The next plan you try depends on what you tried before. But other things matter, too, like:

  • Your age
  • Your overall health
  • Your platelet count
  • If you have bleeding and how much
  • How active you are
  • The side effects and cost of a treatment
  • What you prefer

How to Get the Most Out of Your Treatment

To give your medicines the best chance to work:

  • Skip high-impact sports like football, boxing, martial arts, and snowboarding. Swimming, tennis, biking (with a helmet), and track are better options.
  • Don’t take any medicines or supplements that cause bleeding, including ibuprofen, aspirin, Coumadin, and fish oil.
  • Don’t smoke. Ask your doctor about how you can quit.
  • Choose foods that help your blood clot, like spinach, kale, and other dark, leafy greens. Limit caffeine and alcohol. They can affect how your platelets work.
  • Ask your doctor about vitamin D and calcium supplements. They could help bring your platelet count up. 

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