{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T02:02:16Z","timestamp":1785290536394,"version":"3.55.0"},"reference-count":72,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,10,21]],"date-time":"2018-10-21T00:00:00Z","timestamp":1540080000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100002429","name":"Amgen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100002429","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Hematol"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Immune thrombocytopenia (ITP) is a rare platelet disorder that is often persistent or chronic in adults. Patient management is dependent upon physician judgment and patient preference, given both the rarity of the condition and a paucity of high\u2010quality clinical trial evidence to inform practice guidelines. A systematic literature review was conducted to provide an up\u2010to\u2010date summary of studies evaluating the safety and efficacy\/effectiveness of therapies used to treat adults with primary ITP in the second\u2010line setting. Using comprehensive search strings, several medical research databases were queried. Final abstraction was performed on 186 articles. Most (75%) studies were observational in nature; nearly half were conducted in Europe. Splenectomy was the most commonly studied (n\u2009=\u200983, 47%), followed by rituximab (n\u2009=\u200949, 26%) and the thrombopoietin\u2010receptor agonists (TPO\u2010RAs) romiplostim (n\u2009=\u200934, 18%) and eltrombopag (n\u2009=\u200924, 13%). Twelve prospective, randomized controlled trials (RCTs) with a placebo or standard\u2010of\u2010care arm evaluating the safety and efficacy of either rituximab or a TPO\u2010RA were identified and described in detail. These trials provide important information on the safety and efficacy of these treatments, and in the absence of head\u2010to\u2010head data, offer insights on how these therapies compare with one another in treating adult ITP in the second\u2010line setting. This review confirms that for most second\u2010line ITP treatment options, there remains a lack of rigorous evidence derived from RCTs, and for many treatments, there is limited evidence of any kind. The need for additional research to guide treatment choices in this setting and greater use of standardized ITP terminology are highlighted.<\/jats:p>","DOI":"10.1002\/ajh.25301","type":"journal-article","created":{"date-parts":[[2018,9,28]],"date-time":"2018-09-28T22:12:52Z","timestamp":1538172772000},"page":"118-132","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Systematic literature review of treatments used for adult immune thrombocytopenia in the second\u2010line setting"],"prefix":"10.1002","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3091-6090","authenticated-orcid":false,"given":"Lauren C.","family":"Bylsma","sequence":"first","affiliation":[{"name":"EpidStat Institute  Ann Arbor Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon P.","family":"Fryzek","sequence":"additional","affiliation":[{"name":"EpidStat Institute  Ann Arbor Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karynsa","family":"Cetin","sequence":"additional","affiliation":[{"name":"Center for Observational Research, Amgen, Inc.  Thousand Oaks California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Callaghan","sequence":"additional","affiliation":[{"name":"Center for Observational Research, Amgen, Inc.  Thousand Oaks California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Bezold","sequence":"additional","affiliation":[{"name":"EpidStat Institute  Ann Arbor Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhakti","family":"Mehta","sequence":"additional","affiliation":[{"name":"Global Development, Amgen, Inc.  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