Combinaiton of thrombopoietin agenst -pr0
The approach of combiining thrombopoietin receptor agents is very new, but some literature supports it, and ti is being increasingly used in refractory cases.
A small proportion of both children and adults do not respond to conventional first or secondline treatments. Increasingly, splenectomy is not proposed, declined or contraindicated. Some patients with severe ITP, before or after splenectomy, therefore may benefit from combination therapy (Miltiadous et al., 2020).
In this retrospective study, we report safety and efficacy of combination therapy with thrombopoietin receptor agonists (TPORAs) romiplostim or eltrombopag; immunosuppressants ciclosporin A (CSA) or mycophenolate mofetil (MMF); and intravenous immunoglobulin G (IVIG).
Miltiadous, O., Ming, H. & Bussel, J. (2020) Identifying and treating refractory ITP: difficulty in diagnosis and role of combination treatment. Blood. 135, 472490.
Sif Gudbrandsdottir et al, Combination of thrombopoietin receptor agonists, immunosuppressants and intravenous immunoglobulin as treatment of severe refractory immune thrombocytopenia in adults and children BJ Heam Volume189, Issue2 April 2020
Pages e37-e40