James B. Bussel, MD, explains the effects that long-term immunosuppressive therapy can have on patients with immune thrombocytopenia.
Long-term corticosteroid use has many side effects could induce the existence of diabetes mellitus it could lead to osteoporosis many people mind that it leads to weight gain it affects personality can cause stomach upset can cause hypertension and those are just some of the things that it can do so there’s pretty good agreement that steroids in the short term
Are fine but steroids in the long term are anathema to good medical practice other immunosuppressive agents are typically not there do not have that much in the way of toxicity even though people worry about them usually it’s more an issue of how well do they work they typically work in less than half the patients and depending on which one which agent you’re
Referring to they may take months to work even if they’re going to work and if for example you use a zetha apron which is probably the longest used agent outside of steroids may take two to three months to work and as indicated does not have that high a response rate number of people who get infections or the number of people who have abnormal liver tests is
Not very high but needs to be continually monitored mycophenolate moffitt ile is thought to be potentially more effective and potentially have less side effects probably the most the biggest issue for immunosuppression and infection is that if somebody gets a cold it may be a more severe cold and may take longer to go away while this doesn’t sound very major
Is annoying and can contribute to the platelet count falling and staying down for longer in addition some people don’t tolerate it well because of headaches and that in turn is a factor of what is the optimal dose some people feel they can use a low dose and it’ll be highly effective other people’s experience is not quite that and it may depend on which patient
Population is being treated cyclosporine is clearly stronger than the other two agents and may have a higher response rate but definitely has more side-effects definitely has more side effects but and needs as a result to be monitored more carefully levels need to be obtained at regular intervals because of the possibility of kidney toxicity and there’s also the
Issue of neurologic problems with it finally none of these agents seem to be very curative the same could be said for other agents such as dan issel and dapsone which have been widely used and generally are tolerable although many women and many women physicians will not use dan issel because of its effects on hirsutism among other issues so immunosuppressive
Agents have lost a lot of their use outside of the pediatric population and even there
Transcribed from video
Effects of Long-Term Immunosuppressive Therapy By Targeted Oncology
