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International Journal of Hematology
Published in: International Journal of Hematology 3/2020

01-03-2020 | Splenectomy | Guideline

Reference guide for management of adult immune thrombocytopenia in Japan: 2019 Revision

Authors: Hirokazu Kashiwagi, Masataka Kuwana, Takaaki Hato, Toshiro Takafuta, Kingo Fujimura, Yoshiyuki Kurata, Mitsuru Murata, Yoshiaki Tomiyama, Committee for the Revision of “Reference Guide for Management of adult ITP” Blood Coagulation Abnormalities Research Team, Research on Rare and Intractable Disease supported by Health, Labour and Welfare Science Research Grants

Published in: International Journal of Hematology | Issue 3/2020

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Excerpt

In 2012, ITP group of Blood Coagulation Abnormalities Research Team with funding from the Ministry of Health, Labour and Welfare Research Grant for Overcoming Intractable Diseases in Japan published a reference guide for management of adult immune thrombocytopenia (ITP) [1]. The reference guide was based on the existing global standards on ITP treatment, as well as research outcomes and expert opinions, and reflected the experience in Japan at that time. A feature of the reference guide was clarification of H. pylori-associated ITP, which is a unique characteristic of ITP cases in Japan. The reference guide also clarified the criteria for starting treatment for ITP, as well as the treatment target and presented a flowchart of treatment, with corticosteroids as first-line treatment, splenectomy as second-line and other treatments as third-line, together with the respective recommendation levels. The basic concepts of management of adult ITP have not changed significantly since that time, and the 2012 reference guide remains adequately effective. However, in the reference guide, thrombopoietin receptor agonists (TPO-RAs) were positioned as third-line treatment, as these products had only recently been approved in Japan. Since then, we have accumulated experience in the use of these drugs, and their long-term efficacy and safety continue to become clear. Furthermore, in 2017, the indications for rituximab, which has been positioned as second-line treatment in Europe and the US, were extended to adult ITP in Japan. Conversely, the number of patients undergoing splenectomy is declining, and there is an increasingly large divergence between decisions made in clinical practice and the reference guide regarding the selection of second-line treatment for patients resistant to corticosteroids. There is also an accumulation of new evidence on ITP treatment, including administration methods for corticosteroids used as first-line treatment, namely high-dose dexamethasone (HD-DEX). …
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Metadata
Title
Reference guide for management of adult immune thrombocytopenia in Japan: 2019 Revision
Authors
Hirokazu Kashiwagi
Masataka Kuwana
Takaaki Hato
Toshiro Takafuta
Kingo Fujimura
Yoshiyuki Kurata
Mitsuru Murata
Yoshiaki Tomiyama
Committee for the Revision of “Reference Guide for Management of adult ITP” Blood Coagulation Abnormalities Research Team, Research on Rare and Intractable Disease supported by Health, Labour and Welfare Science Research Grants
Publication date
01-03-2020
Publisher
Springer Singapore
Published in
International Journal of Hematology / Issue 3/2020
Print ISSN: 0925-5710
Electronic ISSN: 1865-3774
DOI
https://doi.org/10.1007/s12185-019-02790-z

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