The Efficacy of Second Line Therapies in Immune Thrombocytopenia Purpura patient


  • Anan Vithitsuwannakun Medicine Saraburi Hospital
  • Anan Promrattanakun


Background: A systematic meta-analysis reported that eltrombopag, rituximab, and splenectomy were effective treatments for elevating platelet counts to more than 100,000/L and decreasing abnormal bleeding in ITP patients. However, the beneficial effects of second -line treatment for ITP, including colchicine, dapsone, azathioprine, and danazol, are unclear due to limited research. This study assessed the efficacy of second-line ITP treatment for patients in Saraburi hospitals in Thailand.
Objective: To evaluate efficacy and platelet count after 6 months of second-line treatment in patients with idiopathic ITP.
Method: The authors conducted a retrospective study to assess the efficacy of 6-month treatment with eltrombopag, rituximab, splenectomy, colchicine, dapsone, azathioprine, danazol, combination treatment of colchicine with azathioprine or dapsone, and azathioprine with dapsone on treatment response, including platelet count. Other adverse events, including abnormal bleeding, thrombosis, hepatitis will also be analyzed the analysis includes patients with idiopathic ITP patients aged above 15 years old who were treated at Hematology Clinic in Saraburi Hospital (Thailand) between January 2007 and December 2022.
Results: 51 Idiopathic ITP patients were 76.4% female. Patients treated with eltrombopag were all completely responsive, while patients treated with splenectomy, azathioprine, colchicine, and dapsone have an overall response rate of more than 80%. The combination of colchicine and dapsone produced an overall response of 60% with a complete response of 20%. Other combinations of azathioprine with dapsone or colchicine provided a partial response of around. Patients who were treated with danazol had no response to such treatment. In this study, the adverse events from second-line treatment such as severe bleeding, thrombosis, and severe hepatitis event were low. All patients’ characteristic factors and second-line ITP treatments associated with treatment response did not meet any statistical significance.
Conclusions: Eltrombopag and splenectomy provide a good clinical response rate and are commonly used for second-line ITP treatments. Despite the fact that colchicine, dapsone, azathioprine, and combination therapy have been used for second-line ITP treatment in clinical practice, their efficacy for ITP treatment was reported to be inferior to that of eltrombopag and



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How to Cite

Vithitsuwannakun, A., & Promrattanakun, A. (2023). The Efficacy of Second Line Therapies in Immune Thrombocytopenia Purpura patient. Saraburi Hospital Medical Journal, 37(1), 31–47. Retrieved from



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