Long-term cost-efficacy of rituximab in immune thrombocytopenic purpura

Sir, Prior to 1981, the only effective treatments for increasing platelet count in immune thrombocytopenic purpura (ITP) were corticosteroids and splenectomy. More recently, intravenous immunoglobulin (IVIg) and Rh immunoglobulin (IV RhIg) have demonstrated efficacy. Other treatments, including danazol, azathioprine, cyclophosphamide, vinca alkaloids and cyclosporin A, are supported by small and mostly uncontrolled clinical trials. When conventional therapy fails, ITP may be a challenging clinical situation, as long-term corticosteroids have severe side-effects, and IVIg loses its efficacy over the long term. Monoclonal antiCD20 antibodies (rituximab) appear to be effective in ITP, but controlled clinical trials are lacking.1 We present a case of refractory ITP with a sustained response to rituximab, and discuss the cost/benefit ratio of other …