{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"HemeTalks: Conversations in Hematology Education","title":"From Steroids to Cure: A Modern Approach to Immune Thrombocytopenic Purpura (ITP)","html":"","width":"100%","height":180,"duration":1763,"description":"Immune thrombocytopenic purpura (ITP) is a diagnosis of exclusion but treating it is anything but straightforward. In this episode, Dr. Adam Cuker (University of Pennsylvania) joins us to break down how the management of ITP is evolving in real time, from diagnostic pitfalls to a preview of the newly released ASH ITP guidelines. We cover first-line corticosteroid strategies, when to add IVIG, how to choose between the many other available options in the second line and later settings. A world-expert in ITP management, Dr. Cuker shares many important clinical pearls and management strategies to help our listeners care for their patients with ITP. \nClinical Pearls:\n1. ITP remains a diagnosis of exclusion with no confirmatory gold-standard test; diagnostic confidence is ultimately established by a robust platelet response to ITP-directed therapy (steroids, IVIG). Roughly two-thirds to three-quarters of adults with primary ITP will follow a chronic course, which should inform prognostic counseling at diagnosis. \n\n2. Frontline management is evolving away from steroid monotherapy. While corticosteroids (prednisone or high-dose dexamethasone) remain the backbone, forthcoming ASH guideline updates support pairing steroids with a thrombopoietin receptor agonist (TPO-RA) or rituximab upfront rather than delaying combination therapy, given emerging evidence this approach may reduce steroid exposure and improve long-term disease course. \n\n3. In the second-line setting, TPO-RAs (eltrombopag, avatrombopag, romiplostim) are generally favored over rituximab given higher overall response rates, though rituximab may be preferable in patients with high thrombotic risk, those averse to chronic medication, or young women with ITP of less than one year's duration, who show higher observed response rates. TPO-RA switching is well supported (i.e., failure of one agent does not preclude response to another). \n\n4. Third-line options (fostamatinib, mycophenylate mofetil, rilzabrutinib),...","thumbnail_url":"https://img.transistorcdn.com/ybjl9FP0yIIoAR9OW4-QMCeW4qWmBKc92wL1zHiuRRM/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9mYzM1/NDgwODVmNTJhYTU0/M2VjOGNiMjVlNzlk/NWI3MS5qcGc.webp","thumbnail_width":300,"thumbnail_height":300}