Dr. Altomare on Treatment Options in ITP

Ivy P. Altomare, MD, associate professor of medicine, Department of Medicine, Duke University School of Medicine, and medical oncologist, Duke Cancer Network, discusses treatment options for patients with immune thrombocytopenia purpura (ITP).

Steroids are a standard of care for patients with ITP in the first-line setting, says Altomare. Steroids are effective in most patients. However, only 30% of patients will maintain their response at 2 years. As such, most patients will relapse and require second-line therapy.

Several thrombopoietin receptor agonists are approved for the treatment of patients with chronic ITP, including eltrombopag (Promacta), romiplostim (Nplate), and avatrombopag (Doptelet), says Altomare. Importantly, these agents do not cause long-term immunosuppression.

Additionally, fostamatinib disodium hexahydrate (fostamatinib; Tavalisse) is a well-tolerated, oral spleen TKI that has demonstrated significant activity in patients with ITP, says Altomare.

These agents have not been compared head-to-head. Additionally, there are no predictive biomarkers to guide treatment selection and sequencing. As such, treatment selection may be influenced by patient preference, physician experience, and payers, concludes Altomare.