Understanding Chronic ITP

What is chronic immune thrombocytopenia?

Chronic immune thrombocytopenia (chronic ITP, also known as chronic immune thrombocytopenic purpura) is a rare blood condition. People who have it do not have enough platelets in their blood. Platelets are blood cells that help stop bruising and bleeding when you get hurt. This low number of platelets can lead to easy bruising and bleeding.

 

Even though it may be scary to be diagnosed with chronic ITP, there is good news:

  • It’s not cancer
  • It’s not contagious
  • It’s often managed with treatment

What are the different ways chronic ITP can affect me?

In people with chronic ITP, platelets drop to dangerously low levels. Why does this happen?

  • The immune system mistakenly attacks and destroys healthy platelets, which grow in the bone marrow
  • The body doesn’t create enough platelets to make up for the platelet destruction

Chronic ITP treatments aim to tackle either or both of these issues.

What is the difference between acute ITP and chronic ITP?

Acute ITP

When you are first diagnosed with ITP (immune thrombocytopenia), your health care team assumes that the ITP is acute ITP, which lasts less than 6 months. They may treat you with treatments that get platelets up quickly, such as steroids or intravenous immunoglobulin (IVIg).

 

Chronic ITP

Chronic ITP is ITP that lasts 6 months or longer. It is the most common form of ITP in adults.

 

If you have chronic ITP, you may have seen your platelets rise with earlier ITP treatments, only to be disappointed when they fell again once treatment was stopped.

 

PROMACTA® (eltrombopag) is a treatment for people with chronic ITP. It may help boost platelets and maintain stable platelet counts after other treatments have not worked well enough or have caused too many side effects.

 

Below are other ITP treatments you may come across as you learn about and explore different treatment options.

Common ITP treatments

Acute ITP

Corticosteroids (steroids)

Most ITP patients start with a round of steroids to stop the body from destroying platelets and quickly raise platelet counts. Unfortunately, steroids can also have side effects, such as insomnia, weight gain, and mood changes. That’s 1 of the reasons why the American Society of Hematology (ASH) recommends the use of steroids for no more than 6 weeks.

 

Intravenous immunoglobulin (IVIg)

IVIg is also an option to raise platelet counts quickly. IVIg is an infusion given with a needle and requires sitting still for some time while the medicine goes into the veins.

Chronic ITP

Thrombopoietin receptor agonists (TPO-RAs)

Instead of trying to stop the body from destroying platelets, TPO-RAs are platelet boosters that encourage the body to make more. ASH recommends the use of TPO-RAs before other chronic ITP treatments (see Monoclonal antibodies and Splenectomy). Currently, there are 2:

  • Nplate® (romiplostim) is an injection that requires a weekly doctor's visit to receive treatment
  • PROMACTA® (eltrombopag) is a once-daily tablet that can be taken wherever and whenever it works for you. It is also available as an oral suspension

 

Monoclonal antibodies

Rituxan® (rituximab) is a monoclonal antibody that suppresses a specific target in the immune system. While part of the ASH guidelines, it is not a US Food and Drug Administration (FDA)-approved treatment for chronic ITP.

 

Splenectomy

A splenectomy is surgery to remove the spleen. While doctors would not normally remove a healthy organ, taking it out can help some people with chronic ITP. However, there is no test to show whether or not a splenectomy will work, and there is always a risk with any surgical procedure.

Nplate is a registered trademark of Amgen Inc. Rituxan is a registered trademark of Biogen.