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This therapeutic strategy is a combination treatment being evaluated for pediatric patients with persistent or chronic primary immune thrombocytopenia (ITP) who have failed or relapsed after glucocorticoid therapy. The regimen combines a thrombopoietin receptor agonist (TPO-RA), such as eltrombopag, hetrombopag, or avatrombopag, with an anti-CD20 monoclonal antibody, such as rituximab or obinutuzumab (referred to as Ortuzumab in some contexts). TPO-RAs are small molecules or biologics that bind to and activate the c-MPL receptor on megakaryocytes, stimulating platelet production in the bone marrow. Anti-CD20 monoclonal antibodies target the CD20 protein on the surface of B cells, leading to their depletion and a subsequent reduction in the production of autoantibodies against platelets. By simultaneously enhancing platelet production and inhibiting immune-mediated platelet destruction, this combination aims to achieve better long-term remission rates than monotherapy. The strategy is currently being investigated in a Phase 4 clinical trial led by the Institute of Hematology & Blood Diseases Hospital in China.
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