Treatment of Refractory Idiopathic Thrombocytopenic Purpura

The immunosuppressive drug azathioprine (Imuran) was used in long-term management of 17 patients with idiopathic thrombocytopenic purpura. Most patients treated were refractory to conventional therapy with splenectomy and corticosteroids. Azathioprine was effective in inducing a complete hematologic and clinical remission in 12 patients and a partial remission in 2 patients. With the exception of transitory and reversible leukopenia, no toxic effects resulted, even after two years of therapy. In the management of idiopathic thrombocytopenic purpura we still consider splenectomy and corticosteroids the treatments of choice. When the disease is refractory to splenectomy and corticosteroids, or when prolonged doses of corticosteroids are required, we recommend therapy with azathioprine. Corticosteroids should be given concomitantly with azathioprine, since they seem to have a synergistic effect, even in patients who have been refractory to corticosteroids.