Hematology · 18 h ago
ASH updates adult primary ITP treatment recommendations
The American Society of Hematology has issued a focused update to its 2019 guidelines for treating adults with primary immune thrombocytopenia (ITP). The recommendations cover initial therapy and treatment after first-line corticosteroids fail, drawing on evidence reviews through July 19, 2025.
- ASH updates treatment guidance for adults with primary ITP.
- Combination therapy is conditionally preferred for initial treatment.
- After corticosteroid failure, a thrombopoietic agent is strongly recommended.
- The guideline includes advice on agent switching and splenectomy.
The American Society of Hematology (ASH) convened a multidisciplinary panel, including two patient representatives, to update recommendations for adults with primary ITP. The panel used the GRADE approach and reviewed evidence available through July 19, 2025; recommendations were also subject to public comment.
For initial treatment, the guideline conditionally recommends combination therapy with rituximab plus corticosteroids or a thrombopoietic agent plus corticosteroids rather than corticosteroids alone. For adults whose ITP has not responded to first-line corticosteroids, it strongly recommends a thrombopoietic agent and conditionally recommends rituximab. The update also includes good practice statements on switching between thrombopoietic agents and on splenectomy.
These recommendations provide updated options for treatment discussions in adult primary ITP. The abstract does not report effect estimates or provide the evidence certainty for individual options beyond the recommendation strength; the initial combination recommendations are conditional, while the recommendation for a thrombopoietic agent after corticosteroid failure is strong.
In practice
For adults with primary ITP, the updated ASH guideline conditionally favors initial treatment with corticosteroids combined with either rituximab or a thrombopoietic agent over corticosteroids alone. After first-line corticosteroids fail, it strongly recommends a thrombopoietic agent and conditionally recommends rituximab. These recommendations can inform treatment discussions, but the supplied abstract does not give comparative effect estimates or detailed evidence-certainty ratings. The initial-treatment recommendations are conditional, so they should not be interpreted as a universal mandate for combination therapy.
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Blood Advances: American Society of Hematology 2026 guidelines for immune thrombocytopenia: initial and second-line therapy for adults with primary ITP ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.