Treatment Options for Immune Thrombocytopenia (ITP): A Comprehensive Guide

Immune thrombocytopenia, commonly known as ITP, was previously referred to as idiopathic thrombocytopenic purpura. The term has evolved to reflect a deeper understanding of the condition's underlying cause — an autoimmune response in which the body produces antibodies that mistakenly attack and destroy its own platelets. This leads to a significant reduction in platelet count, increasing the risk of bruising and bleeding. ITP can be classified into two main types: primary ITP, where no underlying trigger is identified, and secondary ITP, which occurs in association with other autoimmune disorders such as lupus or certain infections. Today, both forms fall under the umbrella term ITP.

First-Line Treatment Approaches

The cornerstone of initial ITP management focuses on suppressing the immune system's attack on platelets. The most common first-line therapy involves the use of corticosteroids, particularly prednisone, which helps reduce antibody production and slow down platelet destruction. Typically, treatment is initiated when platelet counts drop below 30×10⁹/L, although earlier intervention may be considered if the patient exhibits signs of active or severe bleeding.

Corticosteroid Therapy and Intravenous Support

In cases of extremely low platelet levels or acute bleeding episodes, more aggressive approaches are often necessary. High-dose intravenous corticosteroids, such as methylprednisolone, may be administered for rapid effect. These are frequently combined with intravenous immunoglobulin (IVIG), which works by temporarily blocking the immune system's ability to clear antibody-coated platelets. After this initial phase, patients are usually transitioned to oral prednisone or another steroid form for several weeks to maintain stability and allow time for the immune system to normalize.

Short-Term High-Dose Dexamethasone Regimen

To minimize long-term steroid exposure and associated side effects — including weight gain, osteoporosis, and glucose intolerance — a newer approach using high-dose dexamethasone has gained popularity. This protocol typically involves administering a concentrated dose of dexamethasone over four consecutive days, repeated every two weeks if needed. Many patients respond well to this regimen, achieving sustained remission without requiring prolonged steroid use. If remission is maintained after one or two cycles, medication can often be discontinued entirely.

Second-Line Therapies for Refractory Cases

When first-line treatments fail to produce adequate results, healthcare providers may recommend second-line interventions tailored to the individual patient. These include:

• Splenectomy: Surgical removal of the spleen, once a standard option, reduces the primary site of platelet destruction. While effective in many cases, it is now often delayed due to risks of infection and the availability of less invasive alternatives.
• Immunosuppressive agents: Drugs like rituximab or mycophenolate mofetil modulate the immune system to decrease autoantibody production. Rituximab, a monoclonal antibody targeting B cells, has shown promising response rates, especially in younger patients.
• Thrombopoietin receptor agonists (TPO-RAs): Medications such as eltrombopag and romiplostim stimulate the bone marrow to produce more platelets. These are particularly useful for chronic ITP patients who need long-term control without continuous immunosuppression.

With advancements in medical science, the treatment landscape for ITP continues to evolve. Personalized care plans based on disease severity, patient age, lifestyle, and comorbidities are now the gold standard. Early diagnosis, careful monitoring, and timely intervention significantly improve outcomes, allowing most individuals with ITP to lead normal, active lives.