What are your options for refractory ITP after steroids and TPO for elderly patients?

There are three approved TPO-RA. If a patient fails one, they often respond to another and they can be cycled through all three if need be. Efficacy of TPO-RA may also be improved by adjunctive therapy with low dose prednisone, cyclosporine, etc. Fostamatinib can be used with TPO-RA, or alone. Splenectomy remains a consideration if the patient is medically intact.