{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T05:49:50Z","timestamp":1782107390389,"version":"3.54.5"},"reference-count":44,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Br J Haematol"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    Multirefractory immune thrombocytopenia (ITP) is difficult to manage. The simultaneous administration of an immunosuppressive\/immunomodulatory drug (IS\/IM) and a thrombopoietin receptor agonist (TPO\u2010RA) is increasingly used. We present the experience of the Spanish ITP Group in this retrospective, observational study. Ninety\u2010seven patients with \u22653 failed treatment lines were administered combination therapy (CT) with an IS\/IM and a TPO\u2010RA between January 2021 and December 2023. The IS\/IMs were steroids, purine synthesis inhibitors and fostamatinib. The TPO\u2010RAs were romiplostim, eltrombopag and avatrombopag. Seventy\u2010five (77.3%) patients responded to treatment in a median (interquartile range [IQR]) time of 14 (7\u201352) days. An inverse correlation between previous failures and response was observed (Rho\u2009=\u2009\u22120.290,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.009). After 840 (448\u20131054) days, relapse was reported in 35 (46.7%) of 75 responders (time to relapse: 197 [47\u2013402] days). Relapse was more frequent in chronic ITP patients. Twenty\u2010one patients received a second CT after failure of the first one. Eleven were administered a third CT for the same reason. Response and relapse were similar to those observed with the first CT. Three thromboembolic events and 14 infections that required hospitalization were reported, none fatal. The combination of IS\/IMs and TPO\u2010RAs arises as an alternative option of treatment in multirefractory ITP.\n                  <\/jats:p>","DOI":"10.1111\/bjh.70306","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T13:14:51Z","timestamp":1767359691000},"page":"1036-1045","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Combining an immunomodulatory drug with a TPO\u2010RA to treat multirefractory ITP patients: The Spanish ITP Group experience"],"prefix":"10.1111","volume":"208","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9083-855X","authenticated-orcid":false,"given":"Mar\u00eda\u2010Eva","family":"Mingot\u2010Castellano","sequence":"first","affiliation":[{"name":"Hospital Universitario Virgen del Roc\u00edo, Instituto de Biomedicina de Sevilla (IBIS\/CSIC) Universidad de Sevilla  Sevilla 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