Therapies for immune thrombocytopenia: Advantages and disadvantages

High risk of immunosuppression and other side effects	Advantages	Disadvantages
First-line therapy
Glucocorticoids	Effective Oral administration Familiar Inexpensive Short-term toxicities usually tolerable	Durable response after discontinuation may be uncommon Serious long-term toxicities
Rescue therapy
IVIG	Rapid	Cost Frequent side effects
Second-line and subsequent therapies
Splenectomy	Efficacy Long duration of response	Surgical risks Infectious risks from asplenia Thrombosis risk
Rituximab	Familiar Non-surgical	Less effective than splenectomy Shorter remissions Risks of viral reactivation (especially hepatitis B) Risks of other toxicities (anaphylaxis, pulmonary toxicity)
Thrombopoietin receptor agonists (TPO-RAs)	Efficacy Potential for self-administration Non-surgical No immunosuppression	Require continuous administration Cost
Other immunosuppressive agents or combination therapy	May be effective when other therapies fail to establish a safe platelet count	High risk of immunosuppression and other side effects

Refer to the text of UpToDate topics on the management of immune thrombocytopenia for further details and our approach to management.

IVIG: intravenous immune globulin.

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