Time to platelet count response for immune thrombocytopenia treatments

	Treatment	Initial response* (days)	Peak response^¶ (days)
First-line therapies	Dexamethasone	2 to 14	4 to 28
	Prednisone	4 to 14	7 to 28
	IVIG	1 to 3	2 to 7
	Anti-D	1 to 3	3 to 7
Second-line therapies	Splenectomy	1 to 56	7 to 56
	Rituximab	7 to 56	14 to 180
	Avatrombopag	3 to 5^Δ	13 to 16
	Eltrombopag	7 to 14^Δ	14 to 90
	Romiplostim	7 to 14^Δ	14 to 60
Other therapies	Azathioprine	30 to 90	30 to 180
	Danazol	14 to 90	28 to 180
	Fostamatinib	15
	MMF
	Vinblastine	7 to 14	7 to 42
	Vincristine	7 to 14	7 to 42

The expected time to initial response and peak response with various ITP treatments are listed. Treatments are listed in order of approximate rapidity of the expected initial response. Peak response reflects the time after which response becomes less likely at typically used doses. These data do not address the quality of the response (ie, absolute platelet count reached or percent increase from baseline) or the likelihood of a response for any given treatment. Refer to UpToDate for details of our approach to the initial and subsequent treatment of ITP and the overall efficacy of these treatments.

ITP: immune thrombocytopenia; IVIG: intravenous immune globulin; TPO-RA: thrombopoietin receptor agonist.

* Initial response is the first time that a response could be reasonably expected.

¶ Peak response is the time after which a response becomes less likely at typically used doses.

Δ TPO-RA dose should be titrated upward until an adequate platelet count is achieved or maximum dose is reached.

This table was adapted from research originally published in Blood. Rodeghiero F, Stasi R, Gernsheimer T, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 2009; 113:2386. Copyright © 2009 American Society of Hematology.

Updated with information from:

Neunert C, Lim W, Crowther M, et al. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood 2011; 117:4190.
Dlugosz-Danecka M, Zdziarska J, Jurczak W. Avatrombopag for the treatment of immune thrombocytopenia. Expert Rev Clin Immunol 2019; 15:327.
McBride A, Nayak P, Kreychman Y, et al. Fostamatinib disodium hexahydrate: a novel treatment for adult immune thrombocytopenia. Am J Manag Care 2019; 25:S347.

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Time to platelet count response for immune thrombocytopenia treatments