Based on results of the PINES trial, have you shifted your practice to start treatment for newly diagnosed pediatric ITP with eltrombopag?

I would answer this, "yes and no." As many readers will already know, the PINES trial (Shimano et al., PMID 41123939) was a randomized trial of pediatric patients, between eltrombopag and standard care, in a 2:1 ratio, in newly diagnosed ITP and non-severe bleeding, who required pharmacologic therapy. As the question implies, the result was that the rate of sustained platelet response, the primary outcome variable, was significantly greater in the eltrombopag arm as compared to standard therapy (investigator's choice of glucocorticoids, IVIG, or anti-D globulin).

Let me explain why I say yes and no in answer to the question. On one hand, many experienced ITP treaters were already aware that TPO-receptor agonists could potentially have an ear...