General Updates | Sequencing therapies in immune thrombocytopenia

Sequencing of therapies is the $64,000 question, right? It’s the challenging question that we come across. And I think we will continue to get more information in this regard, but I think it’s really, really important to follow the American Society of Hematology guidelines, which really emphasizes shared decision-making with the patient. And rilzabrutinib and other agents that are in the pipeline, until we have data that’s really comparing one agent to another, which we really don’t have, it’s going to be a discussion with the patient of the risks and the benefits of each therapy option. Immunosuppressants have different risk profiles than thrombopoietin receptor agonists. So I think that it’s really incumbent on us to take the time to review each of the positives and negatives and recognize that certain patients, somebody, for example, who has antiphospholipid antibody syndrome and a history of many thromboembolic events, that’s a different patient in terms of picking a therapy than somebody who has lupus and ITP secondary to their lupus. And there’s opportunities to potentially target two diseases with an immunomodulating drug in one patient, you know, opportunity to avoid using a drug that might have a thromboembolic risk in other patient populations, right? So there are things to consider.

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