Decades of basic science and clinical research have led to an increased understanding of the pathophysiology of
immune thrombocytopenic purpura (
ITP), the processes underlying thrombopoiesis, and the treatment of chronic
ITP. Now, new agents are available to treat
ITP in a nonimmunosuppressive fashion. Lessons learned from the clinical trials of recombinant human
thrombopoietin (TPO) have led to the development of a novel class of compounds: nonimmunogenic agonists of the
thrombopoietin receptor. Representing the first nonimmunosuppressive agents to treat chronic refractory
ITP in decades, medications such as
romiplostim and
eltrombopag were recently approved by the US Food and Drug Administration. These new agents offer physicians a new tool for treating difficult cases of
ITP in their medical armamentarium. Additional TPO mimetics are also being developed that show promise in vitro, and await future development.