Tier 1 treatment options
| Drug . | Dose . | Response rate* . | Time to response (wk) . | Selected toxicities . |
|---|---|---|---|---|
| Low-dose prednisone | ≤5 mg orally once per day | <10% | N/A† | Weight gain, hyperglycemia, hypertension, osteoporosis, cataracts |
| Rituximab | 375 mg/m2 IV once per week × 4 (lower doses may be effective) | 60% overall, 40% complete, 20%-25% at 5 y | 1-8 | Infusion reactions, serum sickness, HBV reactivation, PML (rare) |
| Romiplostim | 1-10 μg/kg SC once per week | 80% overall, 40%-50% persistent | 1-4 | Reticulin fibrosis, rebound thrombocytopenia, thrombosis |
| Eltrombopag | 25-75 mg orally once per day | 80% overall, 40%-50% persistent | 1-2 | Reticulin fibrosis, rebound thrombocytopenia, thrombosis, hepatotoxicity |
| Drug . | Dose . | Response rate* . | Time to response (wk) . | Selected toxicities . |
|---|---|---|---|---|
| Low-dose prednisone | ≤5 mg orally once per day | <10% | N/A† | Weight gain, hyperglycemia, hypertension, osteoporosis, cataracts |
| Rituximab | 375 mg/m2 IV once per week × 4 (lower doses may be effective) | 60% overall, 40% complete, 20%-25% at 5 y | 1-8 | Infusion reactions, serum sickness, HBV reactivation, PML (rare) |
| Romiplostim | 1-10 μg/kg SC once per week | 80% overall, 40%-50% persistent | 1-4 | Reticulin fibrosis, rebound thrombocytopenia, thrombosis |
| Eltrombopag | 25-75 mg orally once per day | 80% overall, 40%-50% persistent | 1-2 | Reticulin fibrosis, rebound thrombocytopenia, thrombosis, hepatotoxicity |
HBV, hepatitis B virus; IV, intravenous; N/A, not applicable; PML, progressive multifocal leukoencephalopathy; SC, subcutaneous.
Studies vary in their definition of response.
In patients who are responding to intermediate or high doses of prednisone, we taper to low-dose prednisone. We do not start low-dose prednisone de novo.