Are non-steroid treatments effective for chronic ITP at 65?

Question

Hello doctor,

I have an aunt who is 65 years old and has been suffering from chronic ITP (immune thrombocytopenia) for close to six years now. Her platelet levels usually range from 30,000 to 50,000, and she tends to bruise easily.

She was treated with steroids multiple times in the past, but they caused weight gain, mood changes, and worsening blood sugar levels, so she is hoping to avoid them now.

Can someone at 65 with chronic ITP still qualify for effective non-steroid treatments?

What newer options are available for people who cannot tolerate repeated steroid therapy?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and understood your problem.

Many people in their 60s and even much older can still qualify for effective non-steroid treatments for chronic ITP (immune thrombocytopenia), especially when steroids have caused significant side effects like weight gain, mood changes, and worsening diabetes or blood sugar control. In fact, modern ITP management increasingly tries to avoid repeated long steroid courses because of those exact problems, particularly in older adults.

For someone like your aunt, whose platelet counts stay around 30,000 to 50,000 with bruising and gum bleeding, hematologists often consider second-line therapies that are safer for long-term use and better tolerated.

The most commonly used newer options are thrombopoietin receptor agonists such as Eltrombopag, Romiplostim, and Avatrombopag, which help the body produce more platelets and can work very well in chronic ITP, often raising counts enough to reduce bleeding risk. This class of drugs is now considered to be the preferred second-line drug due to their efficacy and tolerance.

Other non-steroids include Rituximab that works on immune cells, causing platelet destruction but with temporary effects and affecting infections and vaccine reactions.

Another newer treatment is Fostamatinib, an oral medication that works differently by blocking immune-mediated platelet destruction and is approved for adults with chronic ITP who have not responded adequately to prior therapies.

Some patients may also be candidates for splenectomy, although doctors are usually more cautious about surgery in older adults and often try medical therapies first. Treatment decisions at age 65 are individualized and take into account bleeding symptoms, platelet trends, diabetes, clotting risk, medications, and overall health rather than age alone.

It is understandable that she wants to avoid more steroids after what she experienced, and fortunately, there are now several effective alternatives that did not exist or were not widely used years ago.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.