Nplate vs. Promacta vs. Rituxan

Hey all!
I've been on prednisone since March 9th of this year, after my platelets were found to be 19. It was the second discovered instance of my platelets being in the teens (the first time was September 2016; I was treated with dexamethasone at that time). I've been very slowly tapering down the prednisone (under my doctor's advice and supervision). I finally made it down to 5mg four weeks ago (after having started on 100mg in March). Unfortunately, at the 5mg, my platelets started dropping again. I've had to go back up to 60mg of prednisone until this coming Monday (just so they stop plummeting), when my doctor and I will discuss other treatements.

I'm wondering what success, side effects, failure, etc. everyone has had with Nplate, Promacta, and/or Rituxan. I would really like to avoid Rituxan if I can. Based on the information I've gathered, it seems like the risks of Rituxan aren't worth the benefits unless nothing else works. Also, my husband and I would like to start a family in the near future, so if you have any information or experience with any of these medications and pregnancy, I would love to hear about it!

Thanks!

Rituxan works very well for me. But I think you are right when you said it is not worth the risk unless other treatments do not work. Many people here have good success with Nplate or Promacta and I would have tried those except that I also have hemolytic anemia. I am sure other people here will have the information you need about pregnancy with these medications. Hope you will be able to get off the prednisone soon!

Xaverri wrote: Hey all!
... I'm wondering what success, side effects, failure, etc. everyone has had with Nplate, Promacta, and/or Rituxan...

Hey Xaverri,
Be aware, ITP isn't homogeneous. There seems to be perhaps 4 drug response groups (ref my ITP table), and it is possible to eventually be in a combination.

There are those on here where Nplate caused remission, and the other drugs failed to do that. Those here where Promacta caused remission, and the others failed to. Those here where Rituxan caused remission, and the others failed. One has to roll the dice to know.

Having said that, with a known good steroid response, Rituxan is your highest odds for remission. Is remission the goal? On the other hand as you have discovered, Promacta and Nplate are safer. It is possible, though not that probable, that either of those will give you remission.

I think it is either 6 months or a year one should wait to conceive after Rituxan.

Good luck with whatever you choose !

Hello! I'd say it all depends on your goal. It's not advised to get pregnant while on any of those drugs and I think with Rituxan, you need to wait a year after the treatment to try,

Rituxan can cause remission, but on average, it lasts about 12 months. It has a decent success rate, but not great. The good thing is that you get one treatment a week for four weeks and you're done. If it works, you can forget about ITP for a while. It can take up to twelve weeks to work. The con is the side effects which are rare but can be severe.

Promacta is not difficult to manage and has few side effects. It has a pretty good success rate. It's one pill a day. The dose should be managed to maintain counts around 50k....counts should not be normalized. It's a pretty good option and the one that I would choose.

N-Plate is a weekly injection which also has a pretty good success rate. This dose should also be managed to maintain counts around 50k. The problem with this drug is that sometimes counts drop low between injections as the med wears off. Some people can emotionally handle the drop and some cannot.

You might have known all of this but I wasn't sure. There is no real answer about which one is 'best'...it all depends on what someone is trying to achieve and what they can afford and fit into their lifestyle.