Although there’s currently no cure for immune thrombocytopenia (ITP), treatments can help improve platelet counts and manage symptoms. Some ITP treatments encourage platelet production. Others focus on blocking platelet destruction caused by the immune system.

Many adults with mild ITP can manage it without medication, although your doctor will likely schedule follow-up monitoring appointments and regular blood tests. For children with ITP, their condition might improve without therapy.

Read on to learn more about 13 treatments for ITP and how they work.

The most common first-line treatment for ITP is corticosteroids. These medications decrease inflammation and help prevent the immune system from targeting the body’s platelets. Oral corticosteroids (taken by mouth) help increase platelet count within two to four weeks of starting treatment.

Corticosteroids like prednisone or dexamethasone are taken as pills for a short time to raise platelet counts to a safer level and lower the risk of serious bleeding.

Some serious side effects of corticosteroids include:

• Increased risk of infections
• High blood sugar levels, which may increase diabetes risk
• Eye problems that lead to blurry vision and, in some cases, vision loss
• High blood pressure
• Osteoporosis (weak or brittle bones)
• Buildup of body fluid, which can lead to swollen feet, legs, hands, or arms

Due to the risk of side effects, corticosteroids are usually prescribed as a short-term treatment.

A treatment option similar to IVIG is IV Rho(D) immunoglobulin, also called RhIG. It’s used only in people who have Rh-positive blood and still have their spleen. Researchers aren’t exactly sure how RhIG treatment works, but they believe it stops the spleen from destroying platelets.

Like IVIG, RhIG is given as an infusion, and it can cause similar side effects, such as headache, chills, fever, or nausea. Your doctor may monitor you for several hours after the infusion to make sure you don’t have a serious reaction.

If you have ITP due to a bacterial infection, such as H. pylori, antibiotics may be prescribed to treat the infection. They may also help increase your platelet counts. However, antibiotics would not be prescribed for ITP that is unrelated to a bacterial infection.

Rituximab is a medication used to prevent the immune system from attacking platelets in people with chronic ITP. Sometimes, it’s prescribed alongside dexamethasone (a corticosteroid) to treat people newly diagnosed with ITP. The U.S. Food and Drug Administration (FDA) has approved rituximab for many conditions, but it’s still used off-label for ITP.

Rituximab is given as an IV infusion once a week for four weeks. You may experience symptoms of an infusion reaction. Because rituximab lowers certain B cells that help make antibodies, your immune system may have a harder time fighting infections.

Thrombopoietin receptor agonists (TPO-RAs) are a drug class used as second-line therapy for ITP. These medications mimic the function of the TPO hormone and help activate the production of platelets. Examples of TPO receptor agonists include:

• Avatrombopag (Doptelet, Doptelet Sprinkle)
• Eltrombopag (Promacta)
• Romiplostim (Nplate)

Most TPO-RAs are taken as tablets once daily. Most side effects are mild, such as:

• Nausea
• Fatigue
• Headache
• Achy joints
• Common cold

In rare cases, TPO-RAs can cause blood clotting or liver function issues. While you’re being treated for ITP, your doctor will periodically order blood tests to be sure your liver function and platelet count are within a healthy range.

Fostamatinib (Tavalisse) is a spleen tyrosine kinase inhibitor that can be a second- or third-line therapy for adults with ITP. Fostamatinib blocks an enzyme called spleen tyrosine kinase, which prevents the destruction of platelets by splenic macrophages and helps increase platelet counts.

Fostamatinib is a pill. Side effects can include diarrhea, high blood pressure, a drop in white blood cells, and elevated liver enzymes. Your doctor will periodically monitor your blood and liver levels to make sure they’re healthy.

A pill containing a synthetic testosterone, danazol, may be used off-label to treat ITP if other treatments have failed. It affects the immune system and may take three to six months to work for ITP.

Some side effects include:

• Facial hair growth
• Decreased breast size
• Deeper voice
• Reduced sperm count
• Fluid retention

A splenectomy is a surgical procedure to remove the spleen — an organ that aids the immune system and helps clean the blood. In ITP, the spleen filters out platelets that have antibodies attached. Removing the spleen helps keep those platelets in circulation, improving platelet counts.

Splenectomy is reserved for cases of ITP that are severe, chronic, and symptomatic. It’s not typically recommended for children with ITP since they tend to recover without treatment. Having your spleen removed impairs your immune system and makes it more difficult for your body to fight off certain infections.

What Is the Best Treatment for ITP?

The best treatment for ITP is one that your doctor or healthcare team recommends after considering your input. When determining the right treatment for you, your healthcare provider will consider your specific case of ITP, including your age, symptoms, condition severity, and other health conditions you may have.

Work closely with your doctor to provide feedback about your condition and treatment plan so they can make adjustments as needed.

Join the Conversation

On myITPteam, people share their experiences with immune thrombocytopenia, get advice, and find support from others who understand.

What treatments have you tried for ITP? Which ones have worked best for you? Let others know in the comments below.