Immunosuppressive therapy of idiopathic thrombocytopenic purpura

The autoimmune nature of idiopathic thrombocytopenic purpura, as currently defined, is well established. Manipulations of the immune apparatus aimed at abating this deviant immunologic state may be one mode of approach to the therapy of this disease. Several cytotoxic compounds are capable of inhibiting the primary and secondary immune response to experimentally injected antigens in animals and man. Their beneficial role in the treatment of an autoimmune lupus-like syndrome in NZB mice24 is well documented. In human autoimmune disease, efficacy of the drugs is still to be established. The mechanisms by which immunosuppressive agents effect therapeutic response, and, in particular, whether this action is linked to suppression of immune reactivity needs clarification. Although preliminary analysis of the efficacy of immunosuppressive drugs in idiopathic thrombocytopenic purpura is encouraging, their therapeutic role has not superseded that of conventional management with steroids and splenectomy. Carefully controlled randomized clinical trials are now necessary so that more rational use of these agents can be recommended in future reports.