Traitement du purpura thrombop¡§|nique auto-immun de l?¡¥adulte
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Key points

The lack of controlled studies of the treatment of idiopathic thrombocytopenic purpura (ITP), also known as immune thrombocytopenic purpura, means that no evidence-based recommendations are available.

ITP is a benign disease and severe hemorrhages are rare.

Oral prednisone remains the first-line treatment. In patients with very low platelet counts and significant bleeding, intravenous immunoglobulins and high-dose oral dexamethasone may be an alternative. A validated bleeding score would help physicians use these treatments more effectively.

Splenectomy remains the best curative treatment for adults with chronic ITP and platelet counts <30 ??xA0;109/L after failure of the first-line treatments.

Rituximab is probably the single most effective agent, as well as the least toxic, when splenectomy fails: the short-term response rate is 50 % and the sustained-response rate more than 30 % .

Cytotoxic or other immunosuppressive agents should be reserved for patients with severe disease refractory to both splenectomy and rituximab.

Thrombopoietin receptor agonists are a class of new investigational drugs for which promising results have been reported, but more data regarding long-term safety are needed.

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