Choosing Treatment

PROMACTA

Your child may start with a treatment typically used for newly diagnosed immune thrombocytopenia (ITP). Their platelet count will be consistently monitored to see if therapy is working. If your child's platelet levels do not improve enough within 3 months, your child’s doctor may consider other treatment options proven to be effective in this situation. It’s important to know that it’s not uncommon for ITP to become persistent or chronic despite initial treatment.

 

 

Platelet count ranges

Treatment can be tailored to your child’s needs. In fact, when it comes to choosing an appropriate treatment for your child, there is more to it than just raising their platelet count. When speaking with your child’s doctor, consider the following topics and potential questions:

 

Many health care professionals follow the guidelines of the American Society of Hematology (ASH), the society for doctors who treat blood diseases. Here is an overview of the recommendations you can use when discussing treatment with your child’s doctor.

Newly diagnosed ITP
(sometimes called acute ITP)

Corticosteroids (steroids)
Most patients with ITP start with a round of corticosteroids ("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 one of the reasons why ASH recommends the use of steroids for no more than 6 weeks for adults and no more than 7 days for children.

Intravenous immunoglobulin (IVIg)
IVIg is also an option to raise platelet counts quickly, primarily in adults. IVIg is an infusion given with a needle and requires sitting still for some time while the medicine goes into the veins.

 

 

Persistent or chronic ITP
(lasting ≥3 months despite treatment)

TPO-RAs (thrombopoietin receptor agonists)
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 treatments for persistent or chronic ITP (see Monoclonal antibodies and Splenectomy). Currently, there are 2 TPO-RAs approved for use in pediatric patients:

  • Nplate® (romiplostim) is an injection that requires a weekly doctor visit to receive treatment
  • PROMACTA® (eltrombopag) is a once-daily oral treatment that can be taken wherever and whenever it works for you and your child. PROMACTA comes in both tablets and oral suspension, for people who have difficulty swallowing a pill

Monoclonal antibodies
Rituxan® (rituximab) is an IV infusion 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 ITP.

Splenectomy
Surgery to remove the spleen can help some people with persistent or chronic ITP, although it is associated with an increased risk of infection. There is no test to show whether or not a splenectomy will work, and there is always a risk with any surgical procedure.

Rescue therapy

Sometimes, treatment doesn’t work or it works for a while and then platelets drop again. If platelet levels get too low, your child may receive a different or additional treatment until they feel better again. Your child’s doctor may try to get their platelet count back up with:

  • Steroids
  • IVIg
  • Platelet transfusions

 

 

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