Sorry, I should have given complete history. My daughter's ITP started in Jan 2020. Below is the chronological order of treatments:
Jan 2020: IVIG (She had negative reaction to this, so they stopped after 3 doses)
Feb 2020: Prednisone (She was not responding to the expectation of Hematologist with 35mg, so they stopped)
Mar 2020: IVIG, Prednisone, Promacta, Platelet transfusions
Apr 2020: 4 weeks of Rituximab, Promacta (Rituximab didn't have any effect on her platelets)
May 2020: Increased Promacta to 100 mg from 75 and Sirolimus
Jun 2020: Promacta 150 mg and Sirolimus
Jul 2020: Promacta 100 mg and Sirolimus
Aug 2020: 4 weeks of Rituximab, Promacta (Rituximab didn't have any effect on her platelets), Promacta 100mg, Sirolimus
Sep 2020 to Dec 2021: Promacta 75mg, Sirolimus. During this period, she didn't get any other treatment as the platelets were still fluctuating but no bleeding symptoms
Jan 2022 to Mar 2022: After COVID vaccine, her platelets dropped suddenly and they increased Sirolimus and Promacta to 100mg
Apr 2022: 4 weeks of Rituximab, Stopped Promacta, introduced NPlate 4mcg, Sirolimus, one dose of IVIG
May 2022: NPlate 3mcg (this is when her platelets dropped from 282K to 4K), Sirolimus