Choosing Treatment

PROMACTA

Your child may start with treatment for acute 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, your child’s doctor may begin therapy for chronic ITP. It’s important to know that it’s common for acute ITP to become chronic ITP.

 

platelet count

Understand your child's treatment options

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:

 

Understand professional treatment guidelines

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.

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 1 of the reasons why 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

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 chronic ITP treatments (see Monoclonal antibodies and Splenectomy). Currently, there are 2 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 tablet that can be taken wherever and whenever it works for you and your child. It is also available as an oral suspension for children who have difficulty swallowing a pill

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.

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.