What are your thoughts on adding mycophenolate to steroids in the first line treatment of ITP based on the results of the FLIGHT trial?

This was an impressive study that should alter how upfront ITP is managed. The study was well designed, with randomization against the current standard of care. Efficacy was clear with HR for treatment failure of 0.37 (p=0.0029). What is also nice is that unlike TPO agonists which do not have defined endpoint, the mycophenolate was given for about 6 months and stopped with no retreatment needed, but the durability of therapy is maintained with flat and superior tail of Kaplan Meier curve for 24 months. Adverse events were similar between the two arms. MMF is also inexpensive.

The results were impressive, and if these were seen in a trial of a novel and expensive TPO agonist or Syk inhibitor, there would likely be more publicity and FDA appr...