While there are not many new management therapies for immune thrombocytopenia (ITP) in adults, advances in the treatment of refractory ITP have some clinicians looking for guidance. New ITP guidelines from the American Society of Hematology (ASH) were released in December 2019, and in this exclusive Ƶ video, David J. Kuter, MD, DPhil, of Massachusetts General Hospital in Boston, discusses how the guidelines will help clinicians apply new therapies to their patients.
Following is a transcript of his remarks:
I think that guidelines will allow doctors to participate more actively using medical therapy for ITP. They'll also be encouraged to avoid giving steroids for too long, which is a major side effect of treating ITP. And thirdly, they'll allow us to postpone splenectomy, as I mentioned, for a longer period of time.
There are no new therapies that I can envision will be FDA approved this year for ITP, so what the new guidelines do is allow us to take the old therapies, which became new in the last couple of years, such as the TPR [thrombopoietin receptor] agonists, and apply them early on in ITP patients. But there are no new drugs I can envision coming to the pipeline this year that will change this. There are a lot of new drugs being developed for ITP and this is a very active space for drug development and for us interested in ITP as a disease.
But a lot of therapies including kinase inhibitors, inhibitors of neonatal Fc receptors, immuno-proteasome inhibitors, and other inhibitors, and data presented at the last hematology meeting, allow us to think that these drugs may in the next couple of years be developed for ITP, and allow us to add to our already growing armamentarium of therapies for ITP. But the good news is that ITP patients right now have a lot of options to treat ITP, and it's not just splenectomy.
I think the sea change has happened over the last 10 years and what the guidelines do in particular is allow us to actually put those sea changes into writing, allow us to justify that which many of us have been doing for the past decade.
I think the major thing to remember in ITP is a couple of things: One is minimize steroid exposure. Number two, talk to your patients and ask them what they want to do. Number three, recognize that many patients don't need therapy and live totally well with platelet counts of 20,000 or higher. And lastly, to avoid splenectomy and use it as a last option in your care.