A Comparative Analysis of the Efficacy, Safety and Mechanism of Action of Flebogamma DIF, Fostamatinib and Romiplostim in Immune Thrombocytopenia

Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by immune-mediated platelet destruction, resulting in a platelet count below 100 × 10⁹/L and an increased risk of bleeding complications that significantly impair quality of life. Despite advances in ITP management, the unpredictable and heterogeneous nature of the disease continues to challenge treatment selection. This review compares the efficacy, safety, and mechanisms of action of Fostamatinib, Flebogamma DIF, and Romiplostim in adult and pediatric ITP patients. Peer-reviewed studies published over the past 20 years, including randomized and non-randomized clinical trials, observational studies, and real-world evidence, were screened for relevance, with data extracted on dosage, response rates, safety outcomes, and patient characteristics. The sample sizes varied across studies and were reported when available. Study quality and risk of bias were assessed using the ROBINS-I tools. Flebogamma DIF produced rapid increases in platelet count, although its effects were transient. Fostamatinib, the only oral spleen tyrosine kinase inhibitor approved for ITP, was reported to have demonstrated clinical benefit in adults with refractory disease but was contraindicated in pediatric populations. Romiplostim was reported to show sustained platelet responses and facilitate treatment-free remission, particularly in chronic ITP, with an elevated risk of thrombosis. Overall, these therapies offer distinct advantages depending on disease chronicity, patient age, comorbidities, and treatment history. This review underscores the importance of personalized treatment strategies and highlights the need for further long-term, comparative studies to guide evidence-based ITP management.