Godeau B, Bonnotte B, Michel M
Service de médecine interne, Centre de références sur les cytopénies auto-immunes de l'adulte, CHU Henri Mondor, APHP, UPEC, 94010 Créteil, France.
Service de médecine interne et immunologie clinique, CHU Dijon Bourgogne, Université Bourgogne-Franche Comté, Inserm, EFS UMR1098, 21000 Dijon, France.
Rev Med Interne. 2021 Jan;42(1):25-31. doi: 10.1016/j.revmed.2020.06.018. Epub 2020 Jul 24.
The first line treatment of immune thrombocytopenic purpura (ITP) is well established and based on short course of corticosteroids associated with intravenous immunoglobulins (IVIg) for the most severe forms. Predniso(lo)ne is the corticosteroid agent usually given but dexamethasone appears as an alternative. Some guidelines recommend to use dexamethasone as first line when a rapid increase of platelet count is required. Dexamethasone could be used rather than IVIg for moderate to severe but non life-threatening bleeding manifestations. Other therapeutic options such as anti FcRn monoclonal antibodies or recombinant FcγR currently in development for ITP could be an option in the future. In newly diagnosed ITP, we unfortunately lack robust predictive risk factors of severity and chronic outcome. Identifying such factors could be helpful for considering the early use of some treatments which are commonly used as second or third line.
免疫性血小板减少性紫癜（ITP）的一线治疗方案已得到充分确立，对于最严重的形式，采用短期皮质类固醇联合静脉注射免疫球蛋白（IVIg）。泼尼松（龙）是通常使用的皮质类固醇药物，但地塞米松似乎是一种替代药物。一些指南建议，当需要血小板计数快速增加时，将地塞米松用作一线药物。对于中度至重度但无生命危险的出血表现，可使用地塞米松而非IVIg。目前正在研发的其他治疗选择，如抗FcRn单克隆抗体或重组FcγR，未来可能成为一种选择。不幸的是，在新诊断的ITP中，我们缺乏严重程度和慢性结局的可靠预测风险因素。识别这些因素可能有助于考虑早期使用一些通常用作二线或三线的治疗方法。
