2012;120(5):960C969. receiving RTX+DEX. More serious adverse events (n = 16 vs 9) and infections (n = 11 vs 9) were noted in the RTX+DEX cohort than DEX single-agent cohort. Serum immunoglobulin-G and -A levels were decreased in all that could be tested, but were still within Coptisine the normal range, similar to what was observed by others.9 However, there are publications cautioning against persistent hypogammaglobulinemia Rabbit polyclonal to ZC3H14 following rituximab exposure in patients that received rituximab for autoimmune and autoinflammatory conditions.10 Designing appropriate trials addressing rituximab dosage and scheduling in ITP is imperative and using it concurrently with corticosteroids might actually confer some benefit by minimizing infusion reactions. Using this Danish design as a template, future clinical trials in newly diagnosed ITP patients should study its natural history, pathophysiology, and T- and B-cell dysfunction that can lead to identification and validation of appropriate biomarkers of ITP as the disease evolves in an individual patient. This would allow us to move forward from the prevailing empiricism in ITP therapeutics to effective targeting and appropriate risk-benefit assessment with different classes of medications while being wary of the cost structure for all of them (Table 1). Table 1 Prices of all currently available medications used for ITP do underscore that a multicenter clinical trial in Coptisine adult ITP with long-term follow-up is usually feasible.8 The time has come for clinicians that care for Coptisine patients with newly diagnosed ITP to enroll them in controlled trials to investigate the role of immunosuppression in relation to newer agents such as thrombopoietin agonists. After all, despite insipid characterization by Victor Hugo, Cosettes fortunes do change during the course of em Les Misrables /em from an abused and orphaned urchin to a millionaire heiress of Jean Valjeans wealth and she lives happily ever after married to Marius.11 Let us hope for a comparable outcome for all the new patients with ITP, a relatively common medical condition benevolently neglected by clinical trialists until now. Acknowledgment Drug prices were researched and provided by Dr Timothy Jancel, Pharmacy Department, National Institutes of Health Clinical Center. The author is grateful to Dr Michael Sneller for reviewing the manuscript and providing valuable comments. This research was supported by the Intramural Research Program of the National Institute of Allergy and Infectious Diseases, National Institutes of Health. Footnotes Conflict-of-interest disclosure: The author declares no competing financial interests. REFERENCES 1. Stasi R, Newland AC. ITP: a historical perspective. Br J Haematol. 2011;153(4):437C450. [PubMed] [Google Scholar] 2. Ghanima W, Godeau B, Cines DB, Bussel JB. How I treat immune thrombocytopenia: the choice between splenectomy or a medical therapy as a second-line treatment. Blood. 2012;120(5):960C969. [PubMed] [Google Scholar] 3. Wintrobe MM, Cartwright GE, Palmer JG, Kuhns WJ, Samuels LT. Effect of corticotrophin and cortisone around the blood in various disorders in man. AMA Arch Intern Med. 1951;88(3):310C336. [PubMed] [Google Scholar] 4. Imbach P, Barandun S, d’Apuzzo V, et al. High-dose intravenous gammaglobulin for idiopathic thrombocytopenic purpura in childhood. Lancet. 1981;1(8232):1228C1231. [PubMed] [Google Scholar] 5. Saleh MN, Gutheil J, Moore M, et al. A pilot study of the anti-CD20 monoclonal antibody rituximab in patients with refractory immune system thrombocytopenia. Semin Oncol. 2000;27 (6 Suppl 12):99-103. [PubMed] [Google Scholar] 6. Neunert C, Lim W, Crowther M, Cohen A, Solberg L, Jr, Crowther MA. The American Culture of Hematology 2011 evidence-based practice guide for immune system thrombocytopenia. Bloodstream. 2011;117(16):4190C4207. [PubMed] [Google Scholar] 7. Reff Me personally, Carner K, Chambers KS, et al. Depletion of B cells in with a chimeric mouse human being monoclonal antibody to Compact disc20 vivo. Bloodstream. 1994;83(2):435C445. [PubMed] [Google Scholar] 8. Gudbrandsdottir S, Birgens Coptisine HS, Frederiksen H, et al. Rituximab and dexamethasone vs dexamethasone monotherapy in recently diagnosed individuals with primary immune system thrombocytopenia [released ahead of printing January 8, 2013]. Bloodstream. 2013;121(11):1976C1981. [PubMed] [Google Scholar] 9. Arnold DM, Heddle NM, Carruthers J, et al. A pilot randomized trial of adjuvant placebo or rituximab.

Comments are closed.