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Corticosteroids are the initial treatment for adults with primary immune thrombocytopenia (ITP) and platelet counts of <30 × 109/L; second-line therapies include splenectomy, thrombopoietin-receptor agonists, and rituximab (NEJM JW Oncol Hematol Jun 2011 and Blood 2011; 117:4190). Rituximab selectively depletes B-lymphocytes, but whether suppressing T-lymphocytes with cyclosporine would further improve outcomes has not been evaluated.
Now, Australian investigators have conducted a phase IIb study in which 20 ITP patients who had received ≥2 lines of prior therapy were treated with a single course of triple therapy with oral dexamethasone 40 mg on days 1–4), intravenous rituximab (100 mg on days 7, 14, 21, and 28), and oral cyclosporine (2.5–…