Yokoyama Kenji
Department of Hematology/Oncology, Tokai University Hachioji Hospital.
Rinsho Ketsueki. 2021;62(8):1229-1235. doi: 10.11406/rinketsu.62.1229.
Helicobacter eradication therapy is the first-line therapy for patients with Helicobacter positive idiopathic thrombocytopenic purpura (ITP) in Japan. Indications for treatement in patients with Helicobacter negative, or post-Helicobacter eradicated ITP are platelet counts less than 20×10/l or severe bleeding. The first-line treatment for these patients is corticosteroids. Thrombopoietin receptor agonists (TPO-RAs), rituximab, and splenectomy are second-line treatments for patients with corticosteroid refractory ITP. The choice of a second-line treatment should be determined in consideration of the advantages and disadvantages of each treatment. TPO-RAs are effective in over 80% of patients; however, long-term administration is usually needed. Rituximab treatment ends in four weeks, but its durable response rate is relatively low. The durable response rate of splenectomy is relatively high; however, it causes long-term complications. Effective treatments for patients with ITP who are refractory to second-line treatments have not been established. Some novel drugs are under clinical trials, and a treatment strategy for these patients is expected to be established.
在日本，幽门螺杆菌根除疗法是幽门螺杆菌阳性的特发性血小板减少性紫癜（ITP）患者的一线治疗方法。对于幽门螺杆菌阴性或幽门螺杆菌根除后的ITP患者，治疗指征为血小板计数低于20×10⁹/L或严重出血。这些患者的一线治疗是使用糖皮质激素。血小板生成素受体激动剂（TPO-RAs）、利妥昔单抗和脾切除术是糖皮质激素难治性ITP患者的二线治疗方法。二线治疗方法的选择应综合考虑每种治疗方法的优缺点。TPO-RAs对超过80%的患者有效；然而，通常需要长期给药。利妥昔单抗治疗为期四周，但持久缓解率相对较低。脾切除术的持久缓解率相对较高；然而，它会引起长期并发症。对于二线治疗难治性的ITP患者，尚未确立有效的治疗方法。一些新药正在进行临床试验，预计将为这些患者确立治疗策略。
