Looking long-term: an unmet need in immune thrombocytopenia

Abstract

Immune thrombocytopenia is a rare condition in which patients develop autoimmune platelet destruction coupled with impaired platelet production. This results in severe thrombocytopenia and places patients at risk for haemorrhage. Standard first-line treatment for adults with immune thrombocytopenia is corticosteroids, with either prednisone or dexamethasone. 1 Neunert C Terrell DR Arnold DM et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019; 3: 3829-3866 Crossref PubMed Scopus (334) Google Scholar , 2 Provan D Arnold DM Bussel JB et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv. 2019; 3: 3780-3817 Crossref PubMed Scopus (282) Google Scholar Although this approach is efficacious, most patients are unable to maintain a sustained response and will relapse once medication is discontinued. 3 Cuker A Prak ET Cines DB Can immune thrombocytopenia be cured with medical therapy?. Semin Thromb Hemost. 2015; 41: 395-404 Crossref PubMed Scopus (45) Google Scholar For this reason, alternative approaches have been explored by use of upfront combination therapy in order to provide improved long-term outcomes. In this issue of The Lancet Haematology, authors Lu Sun and colleagues 4 Sun L Wang J Shao L et al. Dexamethasone plus oseltamivir versus dexamethasone in treatment-naive primary immune thrombocytopenia: a multicentre, randomised, open-label, phase 2 trial. Lancet Haematol. 2021; 8: e289-e298 Summary Full Text Full Text PDF Scopus (9) Google Scholar report results on use of combination dexamethasone and oseltamivir for patients with treatment-naive immune thrombocytopenia. Dexamethasone plus oseltamivir versus dexamethasone in treatment-naive primary immune thrombocytopenia: a multicentre, randomised, open-label, phase 2 trialDexamethasone plus oseltamivir offers a readily available combination therapy in the management of newly diagnosed primary immune thrombocytopenia. The preliminary activity of this combination warrants further investigation. Multiple cycles of oseltamivir, as a modification of current first-line treatment, might be more effective in maintaining the platelet response. Full-Text PDF