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Fostamatinib for treating refractory chronic immune thrombocytopenia (ITP)

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Fostamatinib for treating refractory chronic immune thrombocytopenia (ITP)

  • first line of therapy for ITP includes corticosteroids, sometimes in conjunction with IVIg or anti-Rh(D). While these are effective therapies, none reliably induce durable remission (1)
    • second line therapy for ITP may include Rituximab, splenectomy or thrombopoietin receptor agonists (TRAs)
  • fostamitinib
    • is the first spleen tyrosine kinase (Syk) inhibitor approved for the treatment of chronic immune thrombocytopenia (ITP) in adult patients who have had an insufficient response to previous treatment (3)
    • by inhibiting Syk activation in macrophages, fostamatinib blocks autoantibody-mediated platelet phagocytosis

NICE state (3):

  • fostamatinib is recommended as an option for treating refractory chronic immune thrombocytopenia (ITP) in adults, only if:
    • they have previously had a thrombopoietin receptor agonist (TPO-RA), or a TPO-RA is unsuitable
    • the company provides fostamatinib according to the commercial arrangement
  • the NICE committee note that:
    • treatment options for refractory chronic ITP include TPO-RAs, which are mostly followed by rituximab or mycophenolate
    • clinical evidence shows that fostamatinib is effective compared with placebo. There is no clinical trial evidence directly comparing fostamatinib with rituximab or mycophenolate
    • an indirect comparison shows that fostamatinib works better than rituximab at increasing the platelets count

Reference:


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